European Heart Journal Advance Access originally published online on January 31, 2007
European Heart Journal 2007 28(4):433-442; doi:10.1093/eurheartj/ehl539
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The clinical outcome of percutaneous treatment of bifurcation lesions in multivessel coronary artery disease with the sirolimus-eluting stent: insights from the Arterial Revascularization Therapies Study part II (ARTS II)
1 Thoraxcenter, Ba 583, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
2 EMO Centro Cuore Columbus and San Raffaele Hospital, Milan, Italy
3 Institut Cardiovasculaire Paris Sud, Massy, France
4 Lanarkshire Acute Hospitals, Glasgow, UK
5 Chaim Sheba Medical Center, Tel Hashomer, Israel
6 Azienda Ospedaliera Ospedali Riunitit di Bergamo, Bergamo, Italy
7 Klinikum Augsburg, Augsburg, Germany
8 Institute of Cardiology Warsaw, Warsaw, Poland
9 Kerckhoff Klinik, Kardiologie, Bad Nauheim, Germany
10 Cardialysis, B.V., Rotterdam, The Netherlands
11 Cordis Corporation, Miami Lakes, FL, USA
Received 15 May 2006; revised 13 January 2007; accepted 22 January 2007; online publish-ahead-of-print 31 January 2007.
* Corresponding author. Tel: +31 10 463 5260; fax: +31 10 436 9154. E-mail address: p.w.j.c.serruys{at}erasmusmc.nl
See page 383 for the editorial comment on this article (doi:10.1093/eurheartj/ehl252)
Aims Little is known about the impact of treating bifurcations on the overall outcome of multivessel coronary artery disease treated with stenting. This analysis was made to investigate the 1 year clinical outcome of the treatment of bifurcation lesions using sirolimus-eluting stents (SES) in patients with multivessel disease.
Methods and results Among a total of 607 patients (2160 lesions) in the Arterial Revascularization Therapies Study part II (ARTS II), there were 324 patients in whom at least one bifurcation lesion was treated (465 lesions). Patients with bifurcations were compared with those without bifurcations in terms of baseline characteristics and major adverse cardiac and cerebrovascular events (MACCE). Patients with ‘true’ (200 patients) vs. ‘partial’ bifurcations (124 patients) and usage of a one- (263 patients) vs. two-stent strategy (61 patients) were also evaluated. The bifurcation group was associated with more complex lesion and procedural characteristics than the non-bifurcation group. However, there was no significant difference in 1 year MACCE rates between the bifurcation group and the non-bifurcation group (13.3 vs. 11.0%, P = 0.46). MACCE in patients with true bifurcations was 13.0 vs. 13.7% for partial bifurcations (P = 0.87) and 14.1 vs. 9.8% for one- vs. two-stent strategy (P = 0.53).
Conclusions In this trial without angiographic follow-up, the presence of bifurcations did not affect 1 year outcomes after SES implantation. The outcomes in true vs. partial bifurcations and using one vs. two stents were similar when the treatment strategies were left to the operator's discretion.
Key Words: Bifurcation lesion • Multivessel disease • Stent • Sirolimus • Multicentre trial
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