MEDTRONIC - Sponsored Symposium: Advancing Left Main PCI – Evidence, technique, and stent considerations.
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.
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.
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
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)
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.