Five-year clinical outcomes following drug-eluting stent implantation in left main trifurcations

Introduction

Left main (LM) trifurcations are encountered in about 10–20% of LM cases and may require specific treatment strategies [1].

Aim

The aim of this retrospective analysis was to assess the effectiveness and safety of percutaneous coronary interventions with deployment of drug-eluting stents (DES) (both regular drug-eluting stents (rDES) and dedicated bifurcation BiOSS stents) in LM trifurcations in patients with stable coronary artery disease (CAD) and non-ST elevation acute coronary syndrome (NSTE-ACS).

Material and methods

Study population

We retrospectively analyzed data from the BiOSS Expert Registry, the international randomized clinical trial POLBOS I with BiOSS Expert, the BiOSS LIM Registry and the international randomized clinical trial POLBOS I with BiOSS LIM [2–6]. Patients with a final diagnosis of stable CAD or NSTE-ACS were enrolled between 2010 and 2013 in centers in Poland, Spain and Bulgaria. All patients signed the informed consent. Patients with STEMI or Medina type 001 bifurcation lesions were excluded from the registry. Provisional T-stenting (PTS) was the obligatory strategy.
The BiOSS is a coronary, dedicated balloon-expandable bifurcation stent. The platform is made of 316L stainless steel (strut thickness 120 µm) and the stent is coated with a biodegradable polymer that elutes paclitaxel (BiOSS Expert – paclitaxel concentration 1 µg/mm²) or sirolimus (BIOSS LIM – sirolimus concentration – 1.4 µg/mm²). The BiOSS stent consists of two parts, proximal and distal, joined with two connection struts at the middle zone [7]. In the rDES group, the use of any approved rDES available in participating catheterization laboratories was allowed. The POLBOS I trial started in 2010 when paclitaxel-eluting stents were routinely used. The following regular paclitaxel-eluting stents were used: LucChopin2 (1 µg/mm², Balton), Coroflex Please (1 µg/mm², B. Braun), Taxcor (1 µg/mm², Eurocor) and Apollo (1 µg/mm², IK), whereas olimus-eluting stents were as follows: everolimus-eluting stents (Xience, Abbott Vasc; Promus, Boston Scientific), sirolimus-eluting stents (Cypher, Cordis; Prolim, Balton; Orsiro, Biotronik; Cre8, CiD), biolimus-eluting stents (Biomime, Biomime; Biomatrix, Biosensors) and zotarolimus-eluting stents (Resolute Integrity, Medtronic).

Follow-up

Clinical follow-up was performed with office visits or...


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