- Question
- In patients with true left main coronary bifurcation lesions, is a stepwise provisional stenting strategy better than systematic dual-stent implantation?
- Design
- Randomized, open-label, multicenter, parallel-group, investigator-initiated trial conducted in 35 hospitals across 11 European countries, enrolling 467 participants with intention-to-treat analysis; the main follow-up was 3 years.
- Population
- Patients undergoing percutaneous coronary intervention for unprotected true left main bifurcation lesions; mean age 71 years and 23% women.
- Intervention
- Stepwise provisional strategy (n=230), with the side vessel treated only if needed.
- Control
- Upfront dual-stent strategy (n=237), with systematic stenting of both branches.
- Primary outcome
- Composite of major adverse cardiac events: all-cause mortality, any myocardial infarction, or clinically driven target lesion revascularization, adjudicated by an independent events committee.
- Results
- At 3 years the primary endpoint occurred in 54 of 230 patients (23.5%) with the provisional strategy and 70 of 237 (29.5%) with dual stenting (HR 0.75; 95% CI 0.53-1.07; P=0.11). Target lesion revascularization was lower with the provisional strategy (8.3% vs 15.6%; HR 0.50; 95% CI 0.29-0.86; P=0.013).
- Safety
- There were no significant differences in all-cause mortality (10.0% vs 13.1%) or myocardial infarction (12.2% vs 11.0%).
- Conclusion
- Major adverse cardiac events at 3 years did not differ between the two strategies, but the provisional approach reduced target lesion revascularization.
- Why it matters
- Supports the stepwise provisional strategy as the default approach for noncomplex left main bifurcation lesions; smaller side vessels and shorter lesions favored this strategy.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026