The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Influence of Final Kissing Balloon Inflation on Long-term Outcomes After PCI of Distal Left Main Bifurcation Lesions: Analysis From the EXCEL Trial

DOI: 10.4244/EIJ-D-19-00851

1. Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, NY, USA
2. Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, NY, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
3. Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, NY, USA
4. Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, NY, USA
5. Piedmont Heart Institute, Atlanta, GA, USA
6. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
7. Hôpital privé Jacques Cartier, Ramsay Générale de Santé, Massy, France
8. Imperial College of Science, Technology and Medicine, London, United Kingdom
9. Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands
10. Department of Surgery, UH Cleveland Medical Center, Cleveland, OH, USA
11. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
12. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, NY, USA
13. Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, NY, USA
14. Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, NY, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA, United States
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Aims: The impact of final kissing balloon inflation FKBI after percutaneous coronary intervention (PCI) of bifurcation lesions on long-term clinical outcomes remains controversial. We sought to determine the impact of FKBI on 4-year outcomes after PCI of distal left main (LM) bifurcation lesions. 

Methods and results: The EXCEL trial compared PCI with everolimus-eluting stents and coronary artery bypass graft surgery in patients with LM disease. We examined 4-year clinical outcomes after PCI of distal LM bifurcation lesions according to use of FKBI. The primary endpoint was the composite rate of death, myocardial infarction (MI), or stroke. The major secondary endpoint was the composite rate of death, MI, stroke, or ischemia-driven revascularization (IDR). Among 948 patients randomized to PCI, 759 had distal LM lesions treated, 430 of which were treated with 1 stent and 329 of which were treated with 2 or more stents. The 4-year rates of the primary and major secondary endpoints were similar with versus without FKBI in both the 1-stent and ≥2-stent groups in both unadjusted and adjusted analyses.

Conclusions:. In the EXCEL trial, the performance of FKBI after PCI of distal LM bifurcation lesions was not associated with improved 4-year clinical outcomes regardless of whether 1 stent or ≥2 stents were implanted.

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