Abstract
ObjectiveThis study was aimed to compare different stenting techniques for coronary bifurcation disease (CBD).BackgroundPercutaneous coronary intervention (PCI) remains controversial for CBD; over the years, several stent techniques for bifurcation lesions have been used. Current guidelines recommend a provisional single-stent strategy as the preferred method for coronary artery bifurcation lesions. However, several randomized controlled trials (RCT) indicated that two-stent techniques showed better clinical outcomes.MethodsWe systematically searched Embase, PubMed, and Web of Science to include RCTs. The primary endpoint was the major adverse cardiovascular event (MACE). Secondary outcomes were cardiac death, myocardial infarction (MI), target-lesion or target-vessel revascularization (TLR or TVR), and definite or probable stent thrombosis (ST). Finally, we used 26 RCTs and a total of 7257 individuals were randomly assigned to one of the 6 stent techniques and included in this network meta-analysis.ResultsIn our network meta-analysis, double-kissing (DK) crush was significantly more superior to other 5 stent techniques in MACEs: OR vs. provisional 0.40 (95% CI 0.28–0.55); vs. culotte 0.40 (95% CI 0.26–0.60). DK crush ranked the most effective treatment for MACE (100%), MI (75%), ST (83%), and TLR (100%) in the rank probabilities analysis. In patients with complex bifurcation lesion defined by DEFINITION criteria, DK crush was notably more efficacious than provisional, culotte, and T-stenting/T-stenting and protrusion (TAP) in MACEs (OR vs. provisional 0.26, 95% CI 0.13–0.52) and TLR (OR vs. provisional 0.24, 95% CI 0.10–0.58).ConclusionCompared with other stenting techniques, DK crush had a lower incidence of MACEs in CBD. DK crush was significantly associated with a lower rate of MACEs in patients with complex bifurcation lesions defined by the DEFINITION criterion.Graphical abstract
Highlights
Bifurcation lesions is defined as coronary artery stenosis that occurs adjacent to and/or involving in the origin of an important side branch (SB) that the operator does not want to lose
We report an overview of all randomized controlled trials (RCT) that compared 6 stenting techniques in terms of efficacy and clinical outcomes in the Percutaneous coronary intervention (PCI) for bifurcation lesions
T-stenting/T-stenting and protrusion (TAP) in reducing major adverse cardiovascular event (MACE) and TLR; 3) DK crush was most likely to be the best treatment of coronary bifurcation lesion using rank probability analysis
Summary
Bifurcation lesions is defined as coronary artery stenosis that occurs adjacent to and/or involving in the origin of an important side branch (SB) that the operator does not want to lose. It uses binary descriptors to indicate whether there is any lesion in each branch of the bifurcation. It could not provide sufficient information about the true complexity of a given bifurcation lesion. Percutaneous coronary intervention (PCI) remains controversial for coronary bifurcation disease (CBD); over the years, several stent techniques for bifurcation lesions have been used. CBD is common, comprising 15–20% of PCIs. Current guidelines recommend a provisional single-stent strategy as the preferred method for coronary artery bifurcation lesions [3]. Several randomized controlled trials (RCT) indicate that two-stent techniques yield better clinical outcomes [4, 5]
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