EuroPCR 2023: Three-year EBC MAIN results demonstrate need for pragmatism in left main bifurcation stent strategy

David Hildick-Smith delivers three-year EBC MAIN results at EuroPCR 2023

Operators performing percutaneous coronary intervention (PCI) in bifurcation left main stem stenosis should not decide on the number of stents they intend to use prior to the procedure, delegates at EuroPCR 2023 (16–19 May, Paris, France) have heard.

This was the message of David Hildick-Smith (University Hospitals Sussex, Brighton, UK), who delivered three-year findings of the EBC MAIN study during a late-breaking trial session on day one of the EuroPCR meeting. EBC MAIN is a randomised comparison of a provisional versus a systematic dual stent strategy for true bifurcation left main coronary artery disease, involving 467 patients at over 30 centres across Europe. Patients were randomised either to receive the stepwise provisional or dual-stent PCI strategy. The study was initiated by the European Bifurcation Club and supported by Medtronic, whose Resolute Onyx drug-eluting stent platform was used throughout the study.

One-year results of the trial, reported in 2020, indicated that there was no difference in terms of the clinical outcomes of death, myocardial infarction (myocardial infarction) or target lesion revascularisation (TLR) between the planned single stenting and the upfront use of two-stent techniques. The study also showed that 22% of patients randomised to a planned single-stent strategy were ultimately treated with two stents, a fact that was highlighted by Hildick-Smith in his presentation.

Outlining the trial’s three-year results, Hildick-Smith reported that there was no difference in the primary endpoint of death, MI and TLR between the two groups (23% in the provisional cohort vs. 29% in the dual-stent cohort, p=0.02) at 36 months, though he did note that there was almost twice as much TLR in the systematic dual stent group (8 vs. 14%).

“It is not necessary to decide before you do the case how many stents you are going to put in. If I only was allowed one message from this trial, that would be it,” said Hildick-Smith of the results, with particular reference to the significance of the 22% of patients in the provisional group who required a second stent.

The results, he said, reaffirm that the provisional approach is the “technique of choice” for bifurcation left main stem stenosis.


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