In:
Catheterization and Cardiovascular Interventions, Wiley, Vol. 102, No. 3 ( 2023-09), p. 415-429
Abstract:
The impact of intracoronary imaging on outcomes, after provisional versus dual‐stenting for bifurcation left main (LM) lesions, is unknown. Objectives We investigated the effect of intracoronary imaging in the EBC MAIN trial (European Bifurcation Club LM Coronary Stent study). Methods Four hundred and sixty‐seven patients were randomized to dual‐stenting or a stepwise provisional strategy. Four hundred and fifty‐five patients were included. Intravascular ultrasound (IVUS) or optical coherence tomography (OCT) was undertaken at the operator's discretion. The primary endpoint was death, myocardial infarction or target vessel revascularization at 1‐year. Results Intracoronary imaging was undertaken in 179 patients (39%; IVUS = 151, OCT = 28). As a result of IVUS findings, operators reintervened in 42 procedures. The primary outcome did not differ with intracoronary imaging versus angiographic‐guidance (17% vs. 16%; odds ratio [OR]: 0.92 (95% confidence interval [CI] : 0.51−1.63) p = 0.767), nor for reintervention based on IVUS versus none (14% vs. 16%; OR: 0.88 [95% CI: 0.32−2.43] p = 0.803), adjusted for syntax score, lesion calcification and ischemic symptoms. With angiographic‐guidance, primary outcome events were more frequent with dual versus provisional stenting (21% vs. 10%; adjusted OR: 2.11 [95% CI: 1.04−4.30] p = 0.039). With intracoronary imaging, there were numerically fewer primary outcome events with dual versus provisional stenting (13% vs. 21%; adjusted OR: 0.56 [95% CI: 0.22−1.46] p = 0.220). Conclusions In EBC MAIN, the primary outcome did not differ with intracoronary imaging versus none. However, in patients with angiographic‐guidance, outcomes were worse with a dual‐stent than provisional strategy When intracoronary imaging was used, there was a trend toward better outcomes with the dual‐stent than provisional strategy.
Type of Medium:
Online Resource
ISSN:
1522-1946
,
1522-726X
Language:
English
Publisher:
Wiley
Publication Date:
2023
detail.hit.zdb_id:
2001555-0
