Imaging in Bifurcation – Parallel Session Summary

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain IMAGING IN BIFURCATION - PARALLEL SESSION SUMMARY Author: Zlatko Mehmedbegovic, MD, Clinical Center of Serbia, Belgrade, Serbia Balloons & stent sizing…

LM Bifurcation Distal PCI – If You Use Crush Technique It Should Be DK Crush

European Bifurcation Club 2019, EBC 2019 - Barcelona, Spain CONSENSUS SESSION - VOTING LM Bifurcation Distal PCI - If You Use Crush Technique It Should Be DK Crush Author: Imad Sheiban, MD, PhD, Pederzoli Hospital -Pechiera D/G (Verona), Italy Left main Bifurcation : It is different , not MV- SB but 2 MVs .. Optimal treatment should be provided for both branches TAKE HOME MESSAGES: For complex LM BLs, 2-stent technique especially DK crush is associated with Excellent clinical outcome Serial Randomized Clinical Trials were able to demonstrate that in complex bifurcations , DK Crush is associated with better clinical outcome as compared to other techniques and should be be considered a the gold standard when crush technique is used

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

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 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