Clinical Outcomes Following Coronary Bifurcation PCI Techniques: A Systematic Review and Network Meta-Analysis Comprising 5,711 Patients |
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Institution: | 1. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium;2. Department of Advance Biomedical Sciences, Federico II University, Naples, Italy;3. Division of Cardiology and Angiology II, University Heart Centre Freiburg, Bad Krozingen, Bad Krozingen, Germany;4. Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China;5. Key Laboratory of Cardiovascular and Cerebrovascular Medicine, School of Pharmacy, Nanjing Medical University, Nanjing, China;6. Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan;7. Department of Cardiology, Odense University Hospital & University of Southern Denmark, Odense, Denmark;8. Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium;9. “Alexandrovska” University Hospital, Sofia, Bulgaria;10. Department of Cardiology, National University of Ireland, Galway, Ireland;11. Department for Diagnostic and Catheterization Laboratories, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia;12. Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France |
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Abstract: | ObjectivesThe aim of this study was to compare clinical outcomes of different bifurcation percutaneous coronary intervention (PCI) techniques.BackgroundDespite several randomized trials, the optimal PCI technique for bifurcation lesions remains a matter of debate. Provisional stenting has been recommended as the default technique for most bifurcation lesions. Emerging data support double-kissing crush (DK-crush) as a 2-stent technique.MethodsPubMed and Scopus were searched for randomized controlled trials comparing PCI bifurcation techniques for coronary bifurcation lesions. Outcomes of interest were major adverse cardiovascular events (MACE). Secondary outcomes of interest were cardiac death, myocardial infarction, target vessel or lesion revascularization, and stent thrombosis. Summary odds ratios (ORs) were estimated using Bayesian network meta-analysis.ResultsTwenty-one randomized controlled trials including 5,711 patients treated using 5 bifurcation PCI techniques were included. Investigated techniques were provisional stenting, T stenting/T and protrusion, crush, culotte, and DK-crush. Median follow-up duration was 12 months (interquartile range: 9 to 36 months). When all techniques were considered, patients treated using the DK-crush technique had less occurrence of MACE (OR: 0.39; 95% credible interval: 0.26 to 0.55) compared with those treated using provisional stenting, driven by a reduction in target lesion revascularization (OR: 0.36; 95% credible interval: 0.22 to 0.57). No differences were found in cardiac death, myocardial infarction, or stent thrombosis among analyzed PCI techniques. No differences in MACE were observed among provisional stenting, culotte, T stenting/T and protrusion, and crush. In non–left main bifurcations, DK-crush reduced MACE (OR: 0.42; 95% credible interval: 0.24 to 0.66).ConclusionsIn this network meta-analysis, DK-crush was associated with fewer MACE, driven by lower rates of repeat revascularization, whereas no significant differences among techniques were observed for cardiac death, myocardial infarction, and stent thrombosis. A clinical benefit of 2-stent techniques was observed over provisional stenting in bifurcation with side branch lesion length ≥10 mm. |
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