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

Coronary interventions

Influence of final kissing balloon inflation on long-term outcomes after PCI of distal left main bifurcation lesions in the EXCEL trial

EuroIntervention 2020;16:218-224. DOI: 10.4244/EIJ-D-19-00851

1. Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, NY, USA; 2. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; 3. Piedmont Heart Institute, Atlanta, GA, USA; 4. NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA; 5. Hôpital privé Jacques Cartier, Ramsay Générale de Santé, Massy, France; 6. Department of Cardiology, NUIG, National University of Ireland, Galway, Ireland; 7. Imperial College of Science, Technology and Medicine, London, United Kingdom; 8. Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands; 9. Department of Surgery, UH Cleveland Medical Center, Cleveland, OH, USA

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 four-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 (CABG) in patients with left main (LM) disease. We examined four-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 ischaemia-driven revascularisation (IDR). Among 948 patients randomised to PCI, 759 had distal LM lesions treated, 430 of which were treated with one stent and 329 of which were treated with two or more stents. The four-year rates of the primary and major secondary endpoints were similar with versus without FKBI in both the one-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 four-year clinical outcomes regardless of whether one stent or ≥2 stents were implanted.

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