The European Bifurcation Club Randomized Trial of Stepwise Provisional Stenting Versus Drug Coated Balloon Therapy for Non-left Main True Coronary Bifurcations

The European Bifurcation Club Randomized Trial of Stepwise Provisional Stenting Versus Drug Coated Balloon Therapy for Non-left Main True Coronary Bifurcations - EBC DCB Study

Clinical outcomes are worse in patients with coronary artery bifurcation lesions, even if commonly encountered in clinical practice. The use of drug coated balloons within bifurcation lesions offers the acute advantage of a more straightforward procedure, without recrossing and deformation of a stent. Thus, the primary objective of this study is to determine if Drug Coated Balloon treatment of non-left main true coronary artery bifurcation lesions is non-inferior (similar) to a provisional strategy with Drug Eluted Stent deployment.

The EBC DCB study is an investigator-initiated, prospective, multi-centre, open-label, randomized (1:1) non-inferiority trial.

Patients with non-left main bifurcations requiring revascularisation and both the main vessel and side branch significantly diseased ( ≥2.5mm and Medina 1/1/1, 1/0/1 or 0/1/1), constitute the source population. Patients with no more than two additional coronary disease may be considered for the study, with only one bifurcation lesion included.

Patients, pre-selected by their referring physicians, will be screened for eligibility by the study team. If patients fulfill all inclusion and do not meet exclusion criteria, they will be informed about the study's purpose and course and will be asked for participation and written informed consent. 20 sites will be involved, in 7 European countries and South Korea, for a total of 750 patients. After a 2-years recruitment period, the trial will include a Follow-Up period at 6-months, 1-year, 3-years, 5-years and 8-years. The 1-year check point will constitute the primary endpoint where the Bifurcation Orientated Composite Endpoint (BOCE) will be analyzed for non-inferiority (further analysis for superiority, if non-inferiority met).

Inclusion Criteria:

• True non-left main bifurcation disease with both MV and SB involvement (i.e Medina 1/1/1, 1/0/1, 0/1/1)

• Bifurcation lesion responsible for an acute or chronic coronary syndrome with at least one of the following:

  • ≥70% angiographic MV and SB diameter stenosis
  • Positive non-invasive testing for ischaemia
  • Positive coronary physiology for ischaemia

• Significant SB as described by diameter stenosis ≥50% and all of the following:

  • SB length ≥73mm
  • SB diameter ≥2.5mm
  • Absence of another SB emerging distally from the MV
  • Non-dominant circumflex artery, if SB is a diagonal branch.

Exclusion criteria

• Patients <18 years old
• STEMI <48 hours
• Cardiogenic shock
• Chronic total occlusion involving target bifurcation vessels
• In-stent restenosis
• Patient life expectancy <12 months
• >2 other coronary lesions (target or non-target) planned for treatment
• SYNTAX score >32
• Platelet count ≤50x109/mm3
• Left ventricular ejection fraction ≤20%
• Participation in another investigational drug or device study
• Patient unable to give informed consent