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

Coronary interventions

Procedural characteristics and clinical outcomes in patients undergoing percutaneous coronary intervention for left main trifurcation disease: the EXCEL trial

EuroIntervention 2020;16:e982-e988. DOI: 10.4244/EIJ-D-19-00686

1. Piedmont Heart Institute, Atlanta, GA, USA; 2. University Hospitals of Leicester, Leicester, United Kingdom; 3. Department of Cardiology, National University of Ireland, Galway, Ireland; 4. Imperial College of Science, Technology and Medicine, London, United Kingdom; 5. NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA; 6. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA; 7. Ramsay Générale de Santé, Hopital Privé Jacques Cartier, Massy, France; 8. Abiomed, Danvers, MA, USA; 9. Centre Hospitalier de l’Université de Montréal and Hôpital Hôtel-Dieu de Montréal, Montreal, Quebec, Canada; 10. University Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; 11. Department of Surgery, UH Cleveland Medical Center, Cleveland, OH, USA; 12. Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands; 13. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA

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. We therefore aimed to examine the procedural methods and early and late outcomes among patients undergoing distal LM trifurcation versus bifurcation PCI in the EXCEL trial.

Methods and results: Patients with distal LM bifurcation disease randomised to PCI with everolimus-eluting stents in the EXCEL trial were categorised into those with and without trifurcation involvement. Angiographic and procedural characteristics in addition to clinical events up to five-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 five-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). Ischaemia-driven target lesion revascularisation rates were also similar (11.9% vs 12.0%, p=0.94). No significant differences in definite or probable stent thrombosis were observed between treatment groups (1.7% vs 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. ClinicalTrials.gov Identifier: NCT01205776

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