{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T21:14:15Z","timestamp":1791666855348,"version":"4.3.4"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2025,3,4]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>The optimal coronary stenting technique for true left main bifurcation lesions is uncertain. EBC MAIN (European Bifurcation Club Left Main Trial) aimed to evaluate clinical outcomes of a stepwise provisional strategy compared with a systematic dual-stent approach.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>EBC MAIN was a randomized, investigator-initiated, open-label, multicenter, parallel-group trial conducted across 35 hospitals in 11 European countries. A total of 467 participants undergoing percutaneous coronary intervention for unprotected true left main bifurcation lesions were randomly assigned to the stepwise provisional strategy (n=230) or an upfront dual-stent approach (n=237). The mean (SD) age was 71 (10) years and 23% of participants were women. The primary end point was a composite of major adverse cardiac events, defined as all-cause mortality, all myocardial infarction, or clinically driven target lesion revascularization. Events were adjudicated by an independent clinical events committee and all analyses were by the intention-to-treat principle.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              At 3 years, the primary end point occurred in 54 of 230 (23.5%) stepwise provisional and 70 of 237 (29.5%) dual-stent patients (hazard ratio, 0.75 [95% CI, 0.53\u20131.07];\n              <jats:italic>P<\/jats:italic>\n              =0.11). There was no significant difference in all-cause mortality (10.0% versus 13.1%) or myocardial infarction (12.2% versus 11.0%). However, target lesion revascularization was significantly lower in the stepwise provisional group (8.3% versus 15.6%; hazard ratio, 0.50 [95% CI, 0.29\u20130.86];\n              <jats:italic>P<\/jats:italic>\n              =0.013). In this population, the mean side vessel diameter by quantitative angiography was 2.9 mm, and median side vessel lesion length was 5 mm. Significant interactions were identified between the assigned bifurcation strategy and both side vessel diameter and lesion length with respect to the primary outcome (\n              <jats:italic>P<\/jats:italic>\n              =0.009 and\n              <jats:italic>P<\/jats:italic>\n              =0.005, respectively), with smaller vessels (&lt;3.25 mm diameter) and shorter lesions (&lt;10 mm length) favoring the provisional approach.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>In a European population with true left main stem bifurcation coronary disease requiring intervention, there was no difference in major adverse cardiovascular events between stepwise provisional and systematic dual-stent strategies at 3 years. Target lesion revascularization was significantly less frequent with the stepwise provisional approach, which should be the default strategy for noncomplex left main bifurcation coronary intervention.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>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: NCT02497014.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.124.071153","type":"journal-article","created":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T10:00:28Z","timestamp":1738749628000},"page":"612-622","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":24,"title":["Stepwise Provisional Versus Systematic Dual-Stent Strategies for Treatment of True Left Main Coronary Bifurcation Lesions"],"prefix":"10.1161","volume":"151","clinical-trial-number":[{"clinical-trial-number":"nct02497014","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5922-2378","authenticated-orcid":true,"given":"Sandeep","family":"Arunothayaraj","sequence":"first","affiliation":[{"name":"Department of Cardiology, Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton, UK (S.A., J.C., D.H.-S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3642-318X","authenticated-orcid":true,"given":"Mohaned","family":"Egred","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Freeman Hospital &amp; Newcastle University, Newcastle upon Tyne, UK (M.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2842-7861","authenticated-orcid":true,"given":"Adrian P.","family":"Banning","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Oxford Heart Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK (A.P.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Brunel","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, Clinique de Fontaine, Dijon, France (P.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miroslaw","family":"Ferenc","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, University Heart Center Freiburg\u2013Bad Krozingen, Germany (M.F.)."},{"name":"Institute of Heart Diseases, Wroclaw Medical University, Poland (M.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Hovasse","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Institut Cardiovasculaire Paris Sud, Ramsay Sant\u00e9, Massy, France (T.H., T.L., M.-C.M., Y.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3104-7728","authenticated-orcid":true,"given":"Adrian","family":"Wlodarczak","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Poland Miedziowe Centrum Zdrowia Lubin, Poland (A.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0356-9051","authenticated-orcid":true,"given":"Manuel","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Reina Sofia Hospital, University of Cordoba, Spain (M.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Schmitz","sequence":"additional","affiliation":[{"name":"Contilia Heart and Vascular Center, Elisabeth Krankenhaus Essen, Germany (T.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Silvestri","sequence":"additional","affiliation":[{"name":"Department of Cardiology, GCS Axium, Rambot, Aix en Provence, France (M.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3999-0182","authenticated-orcid":true,"given":"Andreis","family":"Erglis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pauls Stradins Clinical University Hospital, University of Latvia, Riga, Latvia (A.E.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7109-9074","authenticated-orcid":true,"given":"Evgeny","family":"Kretov","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, Sibirskiy F\u0435d\u0435r\u0430l Biomedical Research Center Novosibirsk, Russia (E.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7972-9192","authenticated-orcid":true,"given":"Jens Flensted","family":"Lassen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Odense University Hospital, Denmark (J.F.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3505-9112","authenticated-orcid":true,"given":"Alaide","family":"Chieffo","sequence":"additional","affiliation":[{"name":"Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4266-860X","authenticated-orcid":true,"given":"Thierry","family":"Lef\u00e8vre","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Institut Cardiovasculaire Paris Sud, Ramsay Sant\u00e9, Massy, France (T.H., T.L., M.-C.M., Y.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6569-9401","authenticated-orcid":true,"given":"Francesco","family":"Burzotta","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, Rome, Italy (F.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Cockburn","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sussex Cardiac Centre, University Hospitals Sussex NHS Trust, Brighton, UK (S.A., J.C., D.H.-S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4050-6201","authenticated-orcid":true,"given":"Olivier","family":"Darremont","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Clinique Saint-Augustin-Elsan, Bordeaux, France (O.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9414-0885","authenticated-orcid":true,"given":"Goran","family":"Stankovic","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Serbia 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