Coronary bifurcation lesions treated with simple or complex stenting: 5-year survival from patient-level pooled analysis of the Nordic Bifurcation Study and the British Bifurcation Coronary Study

Miles W. Behan
Niels Ramsing Holm
Adam de Belder
James Cockburn
Andrejs Erglis
Matti Niemelä
Nicholas P. Curzen
Keith G Oldroyd
Kari Kervinen
Indulis Kumsars
Paal Gunnes
Rodney H. Stables
Michael Maeng
Jan Ravkilde
Jan Skov Jensen
Evald H Christiansen
Nina Cooter
Terje K. Steigen
Saila Vikman
Leif Thuesen
Jens Flensted Lassen
David Hildick-Smith

AIMS: Randomized trials of coronary bifurcation stenting have shown better outcomes from a simple (provisional) strategy rather than a complex (planned two-stent) strategy in terms of short-term efficacy and safety. Here, we report the 5-year all-cause mortality based on pooled patient-level data from two large bifurcation coronary stenting trials with similar methodology: the Nordic Bifurcation Study (NORDIC I) and the British Bifurcation Coronary Study: old, new, and evolving strategies (BBC ONE).

METHODS AND RESULTS: Both multicentre randomized trials compared simple (provisional T-stenting) vs. complex (culotte, crush, and T-stenting) techniques, using drug-eluting stents. We analysed all-cause death at 5 years. Data were collected from phone follow-up, hospital records, and national mortality tracking. Follow-up was complete for 890 out of 913 patients (97%). Both Simple and Complex groups were similar in terms of patient and lesion characteristics. Five-year mortality was lower among patients who underwent a simple strategy rather than a complex strategy [17 patients (3.8%) vs. 31 patients (7.0%); P = 0.04].

CONCLUSIONS: For coronary bifurcation lesions, a provisional single-stent approach appears to be associated with lower long-term mortality than a systematic dual stenting technique.

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Eur Heart J. 2016 Jun 21;37(24):1923-8.