Application of the MADS classification system in a "mega mammoth" stent trial: Feasibility and preliminary clinical implications.

Katsikis, Athanasios; Chichareon, Ply; Cavalcante, Rafael; Collet, Carlos; Modolo, Rodrigo; Onuma, Yoshinobu; Stankovic, Goran; Louvard, Yves; Vranckx, Pascal; Valgimigli, Marco; Windecker, Stephan; Serruys, Patrick W (2019). Application of the MADS classification system in a "mega mammoth" stent trial: Feasibility and preliminary clinical implications. Catheterization and cardiovascular interventions, 93(1), pp. 57-63. Wiley-Blackwell 10.1002/ccd.27461

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OBJECTIVES AND BACKGROUND We attempted to test the feasibility of application of the MADS classification system in the largest stent trial to date and evaluate the preliminary clinical implications of this approach. METHODS In the randomized GLOBAL LEADERS trial, testing two different antiplatelet strategies in patients undergoing PCI with bivalirudin and biolimus-eluting stents, the e-CRF was dedicated to bifurcation treatment according to the MADS classification. Based on this e-CRF, the techniques used for bifurcations treatment in GLOBAL LEADERS were described and compared with two large, all-comer registries of bifurcations treatment (I-BIGIS and COBIS), used as historical controls. RESULTS Among 15,991 patients enrolled in the trial, 22,921 lesions treated at the index and staged procedure were available for analysis and 2,757 of these lesions were bifurcations and 7 were trifurcation lesions. The e-CRF-based MADS classification was achieved in 2,757 of these lesions (100%). 80.3% of bifurcations were treated using a single stent, 18.9% using 2 stents and 0.7% using 3 stents. Overall, the "main across side first" approach (A) was used in 77.4% with the "side branch first" approach (S) being the second most frequently used technique (10.2%). A single stent was used in the majority of the "A" approach (87.9%). A reduction in the use of 2-stent techniques (from 33.9 to 18.9%) was observed between GLOBAL LEADERS and I-BIGIS. The "A" approach was the most frequently used technique in GLOBAL LEADERS, while in COBIS the "S" strategy was most frequently employed. CONCLUSIONS Application of the MADS classification through an e-CRF was feasible in the largest stent trial today and provided useful information about the trends observed overtime in the treatment of bifurcation lesions.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Valgimigli, Marco and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1522-1946

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Amanda Valle

Date Deposited:

14 Feb 2019 07:04

Last Modified:

21 Nov 2019 04:38

Publisher DOI:

10.1002/ccd.27461

PubMed ID:

30291669

Uncontrolled Keywords:

MADS bifurcation classification coronary treatment

BORIS DOI:

10.7892/boris.124070

URI:

https://boris.unibe.ch/id/eprint/124070

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