Ideal LM

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain LM SESSION Ideal LM Author: Rober Jan Van Geuns, MD, PhD, Radboudumc, The Netherlands CONCLUSIONS After 2 years, in patients undergoing LM-PCI, a Bioabsorbable Polymer Everolimus-Eluting Platinum Chromium stent (Synergy) followed by 4 months DAPT was non-inferior to a Permanent Polymer Everolimus- Eluting Cobalt Chromium stent (Xience) followed by 12 months DAPT with respect to the composite end point of death from any cause or MI or ischemia-driven target vessel revascularization. No difference in ischemic events up to 24 months • No difference in definite/probable stent thrombosis • No stent thrombosis in either group from 4 to 12 months (Synergy off DAPT) Excess BARC 3 or 5 bleeding in short DAPT group but...                                                                                    •4/11 were on OAC/NOAC (2 on triple Rx) and 7/11 were off DAPT                                                                              • Trial not powered for bleeding events

Efficiency of Drug Coated Balloon after Directional Coronary Artherectomy for Coronary Bifurcation Lesions

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain LM SESSION Efficiancy of Drug Coated Balloon after Directional Coronary Artherectomy for Coronary Bifurcation Lesions - DCA/DCB Registry -As an Option of Stent-less PCI Strategy for Bifurcation Lesions- Author: Shunsuke Kitani, MD, Tokeidai Memorial Hospital, Japan BACKGROUND The optimal strategy for bifurcation lesions still remains controversial even in DES era. DCA-alone had high restenosis rate (20-50%) and TLR rate (15-37%) due to excessive intimal hyperplasia after DCA. Combined DCA and DES for bifurcation lesions reduced restenosis rates (Maiin V 1.1%, SB 3.4%). OBJECTIVES To evaluate the efficacy and safety of DCA/DCB forbifurcation lesions. CONCLUSION DCA/DCB for bifurcation lesions provided good clinical outcomes, minimizing side branch damage. DCA/DCB can be one of the good options as stent-less PCI strategy for bifurcation lesions, especially LMT.

EXCEL 5 Years and SYNTAXES 10 years

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain LM SESSION EXCEL 5 Years and SYNTAXES 10 years Author: Patrick Serruys, MD, PhD, Imperial College London, UK TAKE HOME MESSAGES (10 years) First Randomized Trial to report 10-Year Survival after CABG or PCI with drug-eluting stents in patients with de novo Three-Vessel and Left Main Disease Completeness of follow-up at 10-Year = 94% (well-balanced across CABG and PCI) No survival difference in between CABG and PCI at 10 years in overall cohort Increased survival with CABG vs PCI in Three-Vessel disease Comparable survival with CABG vs PCI in Left Main disease Non-compliance to the SS II treatment recommendation resulted in a numerically higher risk of all-cause death at 10 years. TAKE HOME MESSAGES (5 years) Four Randomized Trials to report 5-Year Survival after CABG or PCI with drug-eluting stents in patients with de novo Left Main Disease. No survival difference in between CABG and PCI at 5 years in the left main disease from a pooled patient level meta analysis. In the EXCEL trial, Non-compliance to the SS II treatment recommendation (CABG) resulted in a significantly higher risk of all-cause death when randomised to PCI. Compliance to the SS II treatment recommendation (Equipoise) resulted in a non- significant difference in all-cause mortality when randomised to either CABG or PCI.

Long Term Outcome of DK Crush Studies on LMB

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain LM SESSION Long Term Outcome of DK Crush Studies on LMB Author: Zhaoqing Sun, MD, Shengjing Hospital Affiliated to China Medical University, China SUMMARY A simple LMB lesion can be treated with a single-stent provisional approach ; while a 2-stent strategy is preferred for complex lesions DK-Crush is an optimal choice in 2-stent strategy The ongoing EBC MAIN study will provide additional information on the optimal treatment of LMCA bifurcation lesions

Long Term Results after PCI of Unprotected Distal Left Main Stenosis

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain LM SESSION Long Term Results after PCI of Unprotected Distal Left Main Stenosis Author: Miroslaw Ferenc, MD, University Heart Center Freiburg, Germany CONCLUSIONS Compared with single stenting, double stenting was associated with a significantly higher long-term risk of MACE. Higher incidence of TLR, whereas the risk of death, MI, or stent thrombosis was similar After critical first year the MACE during long term follow-up similar between single and double stenting Randomized study EBC-Main ongoing (single vs double)

NOBLE Five Year Follow Up

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain LM SESSION NOBLE Five Year Follow Up Author: Niels Ramsing Holm, MD, Aarhus University Hospital, Denmark BACKGROUND Initial NOBLE report (LANCET 2016) indicated that PCI was inferior to CABG for MACCE Mortality was similar No difference in stroke Higher rates of spontaneous MI and revascularization after PCI CONCLUSIONS The NOBLE trial is conclusive: PCI was inferior to CABG in treatment of LMCA stenosis at 5 years for the primary endpoint of MACCE  Mortality was similar for PCI and CABG Difference in MACCE driven by higher rates of non-procedural myocardial infarctions and repeat revascularization after PCI SYNTAX score <23 did not identify a subgroup with more balanced outcome CABG had longer index admissions, more reOP, more blood transfusions Heart Team conference AND thorough balanced discussion with the patient

Differential Prognostic Impact of Treatment Strategies for LM Versus Non LM Bifurcation Lesion.

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain LM SESSION Differential Prognostic Impact of Treatment Strategies for LM Versus Non LM Bifurcation Lesion. Lessons from the COBIS Registries Author: Young Bin Song, MD, PhD, Samsung Medical Center, Korea Stent Technique (1-Stent vs. 2-Stent) The 1-stent strategy, if possible, should initially be considered the preferred approach for the tr eatment of coronary bifurcation lesions, especially LM bifurcation lesions. Clinical Outcomes Between LM VS Non-LM Patients with LM bifurcation showed significantly higher risks of target lesion failure, cardiac d eath or myocardial infarction, and target lesion revascularization compared to those with non-L M bifurcation. CONCLUSION & SUMMARY Patients treated with PCI for an LM bifurcation lesion had poorer outcomes than those with a non-LM bifurcation lesion in the era of second-generation DES. In the treatment of LM bifurcation, the 2-stent strategy was associated with a higher risk of T LF than the 1-stent strategy, mainly driven by higher risk of TLR; however, incidence of cardiac death or MI was not different between the strategies, unlike previous results from the COBIS II registry. In the treatment of a non-LM bifurcation, there were no significant differences in TLF, cardiac death or MI, and TLR between the 1-stent and 2-stent strategy groups.