Provisional vs dedicated bifurcation strategy in unprotected Left main disease: A Randomized study

Optimal treatment of coronary bifurcation anatomy remains a subject of debate. Trials of all-comer bifurcation lesions have shown no advantage of dedicated bifurcation strategies and indeed that long-term mortality may be worse with a more complex approach.

For the left main stem, non-randomized data uniformly suggests that outcomes are worse with a two-stent strategy, but randomized data support the double kissing (DK) crush technique for true bifurcation left main stem disease. The European Bifurcation Club Left Main Coronary Stent Study (EBC MAIN) was designed to examine clinical outcomes in patients with distal bifurcation left main stem lesions undergoing intervention, randomly allocated to either a provisional stent strategy, or a dedicated bifurcation stenting strategy.

Four hundred and sixty-seven patients with true left main stem bifurcation lesions requiring intervention were recruited to the EBC MAIN study in 11 European countries. Patients were randomly allocated to a stepwise layered provisional strategy or a systematic dual stent approach.

The primary endpoint of the study was a composite of all-cause death, myocardial infarction, and target lesion revascularization at 12months. Secondary endpoints were the individual components of the primary endpoint, angina status, angina medication, and adjudicated stent thrombosis.