Author + information
- David Kandzari1,
- Anthony Gershlick2,
- Patrick Serruys3,
- Martin Leon4,
- Marie-Claude Morice5,
- Nicholas Lembo6,
- Adrian Banning7,
- Samer Mansour8,
- Manel Sabate9,
- Joseph Sabik10,
- A. Pieter Kappetein11,
- Ovidiu Dressler12 and
- Gregg Stone13
- 1Piedmont Heart Institute, Atlanta, Georgia, United States
- 2University of Leicester, Leicester, United Kingdom
- 3Imperial College, London, United Kingdom
- 4Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
- 5CERC, Massy, France
- 6Columbia University, New York, New York, United States
- 7John Radcliffe Hospital, Oxford, United Kingdom
- 8Centre Hospitalier de l'Universite de Montreal
- 9Hospital Clínic; University of Barcelona, Barcelona, Spain
- 10Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, United States
- 11Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- 12Cardiovascular Research Foundation, New York, New York, United States
- 13Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
Limited data exist regarding procedural strategy and clinical outcomes of PCI in pts with trifurcation disease of the distal left main (LM) coronary artery.
Pts with LM disease randomized to PCI with everolimus-eluting stents (EES) in the EXCEL trial were categorized into those with and without trifurcation involvement. Clinical and angiographic characteristics, procedural methods and clinical events through 3-year follow-up after PCI were compared between pts with and without trifurcation disease. Multivariable Cox proportional hazards regression was performed to adjust for differences in baseline characteristics including angiographic complexity.
Among 605 pts with site-reported distal LM disease, 61 pts (10.1%) had a trifurcation lesion. No significant differences in clinical characteristics were observed in pts with distal LM disease with and without trifurcation involvement. Mean number of stents used in pts with and without trifurcation disease was 1.7 ± 1.0 vs. 1.6 ± 0.7 respectively, P=0.26; 1, 2 and 3 stents were used in 50.8%, 29.5%, and 19.7% respectively of pts with LM trifurcation disease. Procedure duration and procedural complications were similar between those with and without trifurcation disease. The 3-year primary composite endpoint of death, MI, or stroke occurred in 10.4% of pts with trifurcation disease compared with 14.9% of pts with distal bifurcation disease only (adjusted hazard ratio (HR) 0.60, 95% confidence interval [0.24, 1.49], adjusted P=0.27). Ischemia-driven target lesion revascularization rates were also similar (14.0% vs. 12.5%, P=0.87). No significant differences in definite/probable stent thrombosis were observed between treatment groups (1.7% vs. 1.9%, p=0.90).
Despite the greater inherent complexity associated with LM trifurcation disease, in the EXCEL trial procedural and long-term clinical outcomes following PCI with EES were similar to treatment for distal LM bifurcation disease. These findings support PCI as a treatment strategy for selected pts with distal LM trifurcation disease.
CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)