{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T21:14:14Z","timestamp":1791666854381,"version":"4.3.4"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Distal left main (LM) coronary artery bifurcation disease increases percutaneous coronary intervention (PCI) procedural complexity and is associated with worse outcomes than isolated ostial\/shaft disease. The optimal treatment strategy for distal LM disease is undetermined. We sought to determine whether outcomes after PCI of LM distal bifurcation lesions are influenced by treatment with a provisional 1-stent versus planned 2-stent technique, and if so, whether such differences are conditioned by the complexity of the LM bifurcation lesion.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results:<\/jats:title>\n            <jats:p>\n              The clinical and angiographic characteristics, procedural methods and outcomes, and clinical events through 3-year follow-up were compared in patients undergoing distal LM PCI with a 1-stent provisional versus planned 2-stent technique in the EXCEL trial (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization). Among 529 patients undergoing planned distal LM PCI, 344 (65.0%) and 185 (35.0%) were treated with intended 1-stent provisional and planned 2-stent techniques, respectively. The primary composite end point rate of death, myocardial infarction, or stroke at 3 years was significantly lower in patients treated with the provisional 1-stent versus planned 2-stent method (14.1% versus 20.7%; adjusted hazard ratio, 0.55; 95% CI, 0.35\u20130.88;\n              <jats:italic>P<\/jats:italic>\n              =0.01), driven by differences in cardiovascular death (3.3% versus 8.3%,\n              <jats:italic>P<\/jats:italic>\n              =0.01) and myocardial infarction (7.7% versus 12.8%,\n              <jats:italic>P<\/jats:italic>\n              =0.06). The 3-year rate of ischemia-driven revascularization of the LM complex was also lower in the provisional group (7.2% versus 16.3%,\n              <jats:italic>P<\/jats:italic>\n              =0.001). In 342 patients with distal LM bifurcation disease that did not involve both major side branch vessels, the 3-year primary end point was lower with a provisional 1-stent versus planned 2-stent technique (13.8% versus 23.3%,\n              <jats:italic>P<\/jats:italic>\n              =0.04), whereas no significant difference was present in 182 patients with distal LM bifurcation disease that did involve both side branch vessels (14.3% versus 19.2%,\n              <jats:italic>P<\/jats:italic>\n              =0.36).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Among patients with distal LM bifurcation disease in the EXCEL trial randomized to PCI, 3-year adverse outcomes were worse with planned 2-stent treatment compared with a provisional 1-stent approach, a difference that was confined to patients without major involvement of both LM side branch vessels.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier: NCT01205776.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circinterventions.118.007007","type":"journal-article","created":{"date-parts":[[2018,10,11]],"date-time":"2018-10-11T09:00:54Z","timestamp":1539248454000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":56,"title":["Outcomes Among Patients Undergoing Distal Left Main Percutaneous Coronary Intervention"],"prefix":"10.1161","volume":"11","author":[{"given":"David E.","family":"Kandzari","sequence":"first","affiliation":[{"name":"Piedmont Heart Institute, Atlanta, GA (D.E.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony H.","family":"Gershlick","sequence":"additional","affiliation":[{"name":"Leicester Biomedical Research Centre, University Hospitals of Leicester, University of Leicester, United Kingdom (A.H.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick W.","family":"Serruys","sequence":"additional","affiliation":[{"name":"Imperial College of Science, Technology and Medicine, London, United Kingdom (P.W.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin B.","family":"Leon","sequence":"additional","affiliation":[{"name":"Center for Interventional Vascular Therapy, Division of Cardiology, New York-Presbyterian Hospital\/Columbia University Medical Center (M.B.L., N.J.L., G.W.S.)."},{"name":"Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.B.L., N.J.L., P.G., O.D., G.W.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Claude","family":"Morice","sequence":"additional","affiliation":[{"name":"Ramsay G\u00e9n\u00e9rale de Sant\u00e9, H\u00f4pital Priv\u00e9 Jacques Cartier, Massy, France (M.-C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles A.","family":"Simonton","sequence":"additional","affiliation":[{"name":"Abbott Vascular, Inc, Santa Clara, CA (C.A.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas J.","family":"Lembo","sequence":"additional","affiliation":[{"name":"Center for Interventional Vascular Therapy, Division of Cardiology, New York-Presbyterian Hospital\/Columbia University Medical Center (M.B.L., N.J.L., G.W.S.)."},{"name":"Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.B.L., N.J.L., P.G., O.D., G.W.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian P.","family":"Banning","sequence":"additional","affiliation":[{"name":"John Radcliffe Hospital, Oxford, United Kingdom (A.P.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B\u00e9la","family":"Merkely","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center, Semmelweis University, Budapest, Hungary (B.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ad J.","family":"van Boven","sequence":"additional","affiliation":[{"name":"Medisch Centrum Leeuwarden, The Netherlands (A.J.v.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imre","family":"Ungi","sequence":"additional","affiliation":[{"name":"Cardiology Center, University of Szeged, Hungary (I.U.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arie Pieter","family":"Kappetein","sequence":"additional","affiliation":[{"name":"Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands (A.P.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"Joseph F.","family":"Sabik","sequence":"additional","affiliation":[{"name":"Department of Surgery, UH Cleveland Medical Center, OH (J.F.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"G\u00e9n\u00e9reux","sequence":"additional","affiliation":[{"name":"Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.B.L., N.J.L., P.G., O.D., G.W.S.)."},{"name":"Gagnon Cardiovascular Institute, Morristown Medical Center, NJ (P.G.)."},{"name":"H\u00f4pital du Sacr\u00e9-Coeur de Montr\u00e9al, Qu\u00e9bec, Canada (P.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ovidiu","family":"Dressler","sequence":"additional","affiliation":[{"name":"Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.B.L., N.J.L., P.G., O.D., G.W.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregg W.","family":"Stone","sequence":"additional","affiliation":[{"name":"Center for Interventional Vascular Therapy, Division of Cardiology, New York-Presbyterian Hospital\/Columbia University Medical Center (M.B.L., N.J.L., G.W.S.)."},{"name":"Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.B.L., N.J.L., P.G., O.D., 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