Bifurcation left main stenting with or without intracoronary imaging: Outcomes from the EBC MAIN trial
Abstract
Background
The impact of intracoronary imaging on outcomes, after provisional versus dual-stenting for bifurcation left main (LM) lesions, is unknown.
Objectives
We investigated the effect of intracoronary imaging in the EBC MAIN trial (European Bifurcation Club LM Coronary Stent study).
Methods
Four hundred and sixty-seven patients were randomized to dual-stenting or a stepwise provisional strategy. Four hundred and fifty-five patients were included. Intravascular ultrasound (IVUS) or optical coherence tomography (OCT) was undertaken at the operator's discretion. The primary endpoint was death, myocardial infarction or target vessel revascularization at 1-year.
Results
Intracoronary imaging was undertaken in 179 patients (39%; IVUS = 151, OCT = 28). As a result of IVUS findings, operators reintervened in 42 procedures. The primary outcome did not differ with intracoronary imaging versus angiographic-guidance (17% vs. 16%; odds ratio [OR]: 0.92 (95% confidence interval [CI]: 0.51−1.63) p = 0.767), nor for reintervention based on IVUS versus none (14% vs. 16%; OR: 0.88 [95% CI: 0.32−2.43] p = 0.803), adjusted for syntax score, lesion calcification and ischemic symptoms. With angiographic-guidance, primary outcome events were more frequent with dual versus provisional stenting (21% vs. 10%; adjusted OR: 2.11 [95% CI: 1.04−4.30] p = 0.039). With intracoronary imaging, there were numerically fewer primary outcome events with dual versus provisional stenting (13% vs. 21%; adjusted OR: 0.56 [95% CI: 0.22−1.46] p = 0.220).
Conclusions
In EBC MAIN, the primary outcome did not differ with intracoronary imaging versus none. However, in patients with angiographic-guidance, outcomes were worse with a dual-stent than provisional strategy When intracoronary imaging was used, there was a trend toward better outcomes with the dual-stent than provisional strategy.
CONFLICTS OF INTEREST STATEMENT
D. H.-S. Proctor/Advisory Boston, Abbott, Medtronic, Terumo, Edwards, Occlutech, Gore; CERC. M. E.: Honorarium, proctorship and speaker fees from Abbott, Boston Scientific, Terumo, Phillips, Vascular Perspectives, Teleflex and Miracor. A. C.: Consultant Abiomed, Biosensor, Magenta; Speakers fees Abbott vascular, Abiomed, Boston Scientific, Cardinal Health. T. L.: Abbott Proctoring, Edwards Proctoring, Lectures, Boston scientific, Terumo Proctoring, lectures, Medtronic speaker fees. M.-C. M.: CERC CEO. M. P.: Lecture fees Abbott, Boston, Philips, Asahi. J. F. L.: Lecturing and Honoraria for Medtronic, Boston Scientific, Biotronik, Biosensors. A. B.: Lecture fees Boston. G. S.: Speaker fees Abbott, Terumo, Boston Scientific, Medtronic. A. E. Grant support Abbott, Boston Scientific. O. D.: Lecture fees for Boston and Edwards. The remaining authors declare no conflict of interest.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
