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Published on: November 24, 2014
Procedural characteristics and clinical outcomes in patients undergoing percutaneous coronary intervention for left
David E Kandzari1, Anthony H Gershlick, Patrick W Serruys
1Piedmont Heart Institute, Atlanta, GA, USA.
Insights
Percutaneous coronary intervention (PCI) for distal left main trifurcation disease showed similar procedural and five-year clinical outcomes compared to bifurcation disease. These findings support PCI for selected trifurcation cases.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Medical Device Technology
Background:
- Distal left main (LM) trifurcation disease presents unique challenges for percutaneous coronary intervention (PCI).
- Limited data exist on procedural and clinical outcomes for PCI in distal LM trifurcation versus bifurcation lesions.
Purpose of the Study:
- To compare procedural methods and early/late clinical outcomes of distal LM trifurcation PCI versus bifurcation PCI.
- To evaluate the safety and efficacy of everolimus-eluting stents in treating distal LM trifurcation disease within the EXCEL trial.
Main Methods:
- Retrospective analysis of patients from the EXCEL trial with distal LM disease.
- Categorization of patients into those with trifurcation versus bifurcation anatomy.
- Comparison of angiographic, procedural characteristics, and five-year clinical events (death, myocardial infarction, stroke, revascularization, stent thrombosis).
Main Results:
- Out of 605 patients with distal LM disease, 61 (10.1%) had trifurcation anatomy.
- Five-year primary composite endpoint rates were similar: 16.6% for trifurcation vs. 22.5% for bifurcation (p=0.32).
- Ischemia-driven revascularization (11.9% vs. 12.0%, p=0.94) and stent thrombosis (1.7% vs. 2.3%, p=0.76) rates were also comparable.
Conclusions:
- PCI using everolimus-eluting stents for distal LM trifurcation disease demonstrated similar procedural and long-term outcomes compared to bifurcation disease.
- These results support PCI as a viable treatment strategy for carefully selected patients with distal LM trifurcation disease.
- The findings contribute to understanding treatment options for complex coronary artery disease involving the distal LM.
Aims:
Limited data exist regarding procedural and clinical outcomes of percutaneous coronary intervention (PCI) in patients with trifurcation disease of the distal left main (LM) coronary artery. We therefore aimed to examine the procedural methods and early and late outcomes among patients undergoing distal LM trifurcation versus bifurcation PCI in the EXCEL trial.
Methods And Results:
Patients with distal LM bifurcation disease randomised to PCI with everolimus-eluting stents in the EXCEL trial were categorised into those with and without trifurcation involvement. Angiographic and procedural characteristics in addition to clinical events up to five-year follow-up after PCI were compared. Among 605 patients with site-reported distal LM disease, 61 patients (10.1%) were identified with trifurcation anatomy. The five-year primary composite endpoint of death, myocardial infarction, or stroke occurred in 16.6% of patients with trifurcation disease compared with 22.5% of patients with distal bifurcation disease only (p=0.32). Ischaemia-driven target lesion revascularisation rates were also similar (11.9% vs 12.0%, p=0.94). No significant differences in definite or probable stent thrombosis were observed between treatment groups (1.7% vs 2.3%, p=0.76).
Conclusions:
Despite the greater inherent complexity, procedural and long-term clinical outcomes following PCI of distal LM trifurcations with everolimus-eluting stents in a modest-sized cohort from the EXCEL trial were similar compared with treatment of distal LM bifurcation disease without trifurcations. These findings support PCI as a treatment strategy for selected patients with distal LM trifurcation disease. ClinicalTrials.gov Identifier: NCT01205776.
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