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

Procedural Characteristics and Clinical Outcomes in Patients Undergoing Percutaneous Coronary Intervention for Left Main Trifurcation Disease: The EXCEL trial

DOI: 10.4244/EIJ-D-19-00686

1. Piedmont Heart Institute, Atlanta, GA, USA, United States
2. University Hospitals of Leicester, University of Leicester, Leicester Biomedical Research Centre, Leicester, United Kingdom
3. Imperial College of Science, Technology and Medicine, London, United Kingdom
4. NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA; Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
5. Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France
6. Abbott Vascular, Inc., Santa Clara, CA, USA
7. Centre Hospitalier de l’Université de Montréal and Hôpital Hôtel-Dieu de Montréal, Montreal, Quebec, Canada
8. University Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
9. Department of Surgery, UH Cleveland Medical Center, Cleveland, Ohio, USA
10. Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands
11. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
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Aims: Limited data exist regarding procedural and clinical outcomes of percutaneous coronary intervention (PCI) in patients with trifurcation disease of the distal left main (LM) coronary artery.

Methods and results: Patients with distal LM bifurcation disease randomized to PCI with everolimus-eluting stents in the EXCEL trial were categorized into those with and without trifurcation involvement. Angiographic and procedural characteristics in addition to clinical events through 5-year follow-up after PCI were compared. Among 605 patients with site-reported distal LM disease, 61 patients (10.1%) were identified with trifurcation anatomy. The 5-year primary composite endpoint of death, myocardial infarction, or stroke occurred in 16.6% of patients with trifurcation disease compared with 22.5% of patients with distal bifurcation disease only (p=0.32). Ischemia-driven target lesion revascularization rates were also similar (11.9% versus 12.0%, p=0.94). No significant differences in definite or probable stent thrombosis were observed between treatment groups (1.7% versus 2.3%, p=0.76).

Conclusions: Despite the greater inherent complexity, procedural and long-term clinical outcomes following PCI of distal LM trifurcations with everolimus-eluting stents in a modest-sized cohort from the EXCEL trial were similar compared with treatment of distal LM bifurcation disease without trifurcations. These findings support PCI as a treatment strategy for selected patients with distal LM trifurcation disease.

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