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Background

Learn about outcomes of simple vs complex stenting in bifurcation coronary lesions from combined patient-level data analysis of NORDIC I and BBC ONE trials. Results show benefits of simple strategy in lowering composite endpoint rates at 9 months. Complex strategy did not offer advantages in specific lesion types.

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Background

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  1. Simple or complex stenting for bifurcation coronary lesions: a patient-level pooled-analysis of the Nordic Bifurcation Study (NORDIC I) and the British Bifurcation Coronary Study (BBC ONE) Miles W Behan, Niels R Holm, Nicholas P Curzen,Andrejs Erglis, Rodney H Stables, Adam J de Belder, Matti Niemelä, Nina Cooter, Derek P Chew, Terje K Steigen, Keith G Oldroyd, Jan S Jensen, Jens Flensted Lassen, Leif Thuesen, David Hildick-Smith.

  2. Background The treatment of bifurcation lesions remains a considerable challenge to interventional cardiologists Several trials have compared simple (provisional) vs complex (two-stent) strategies in DES We have combined the patient-level data of two of the largest randomised trials NORDIC I and BBC ONE Large dataset of bifurcation stenting allowing meaningful analysis and subgroup analysis

  3. The Trials 1.Steigen TK. Circulation 2006;114:1955-1961 2.Hildick-Smith D. Circulation 2010;121:1235-1243

  4. Combined Patient-Level Dataset

  5. Myocardial Infarction

  6. Patient Characteristics

  7. Bifurcation Characteristics

  8. Procedure Characteristics

  9. Trial Endpoints

  10. Freedom from 1° Endpoint

  11. Subgroup Analysis True bifurcations (>50% stenosis in each branch) Wide bifurcation angle >60-70° SB ≥ 2.75mm in diameter SB lesion length >5mm SB ≥2.75mm in diameter and lesion >5mm Equivalent sized vessels (SB <0.25mm smaller than MB)

  12. Subgroup Analysis NO ADVANTAGE WITH COMPLEX

  13. Conclusions This pooled analysis of the NORDIC I and BBC ONE Trials shows that the simple strategy is associated with lower rates of the composite endpoint of death, MI and TVR at 9 months. A simple strategy resulted in lower procedure duration, fluoroscopy times, contrast volume and reduced risk of periprocedural MI. Surgical TVR was significantly higher in the Complex group. No benefit of complex strategy in ‘true’ bifurcations, lesions with wide bifurcation angles, those with large SBs, long SB lesions and equivalent sized vessels.

  14. QUESTIONS?

  15. Freedom from MI

  16. Freedom from TVR

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