Definite stent thrombosis after drug‐eluting stent implantation in coronary bifurcation lesions: A meta‐analysis of 3,107 patients from 14 randomized trials

Zhou, Yu; Chen, Shengda; Huang, Lan; Hildick‐Smith, David; Ferenc, Mirosław; Jabbour, Richard J.; Azzalini, Lorenzo; Colombo, Antonio; Chieffo, Alaide; Zhao, Xiaohui

doi:10.1002/ccd.27443

Cited by 11 publications

(11 citation statements)

References 69 publications

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“…The provisional stenting strategy was currently considered the standard approach for the treatment of the majority of CBL. The advantage of balloon angioplasty instead of stent implantation in the side branch treatment was that it was associated with a reduction in definite stent thrombosis, all-cause mortality while restoring anatomy ( 5 , 6 , 26 ). However, the risk of binary restenosis in the long term was still high after the application of traditional balloon angioplasty in the side branch.…”

Section: Discussionmentioning

confidence: 99%

“…The advantage of the provisional stenting strategy is that the side branch treatment remains an open choice throughout the procedure. Early definite stent thrombosis is reduced when a single-stent strategy is used in CBL compared with the double-stent strategy ( 5 ). PCI using a provisional stenting strategy in CBL is associated with a reduction in all-cause mortality at long-term follow-up ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

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Effect of Drug-Coated Balloon in Side Branch Protection for de novo Coronary Bifurcation Lesions: A Systematic Review and Meta-Analysis

Zheng

Wang

et al. 2021

Front. Cardiovasc. Med.

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Background: At present, there are a variety of treatment strategies for percutaneous coronary intervention. The role of drug-coated balloon (DCB) in the treatment of side branch for de novo coronary bifurcated lesions (CBL) is unclear.Objective: To examine the effect of DCB in side branch protection for de novo CBL.Methods: Electronic databases, including Pubmed, Embase, the Web of science, Cochrance library, CNKI, CBM, WanFang Data and VIP were searched for studies that compared DCB with non-drug-coated balloon (NDCB) in side branch protection for de novo CBL from inception through July 7th, 2021. The primary outcome was target lesion revascularization (TLR). Secondary clinical outcomes included myocardial infarction (MI), cardiac death (CD). The angiographic outcomes included side branch late lumen loss (LLL), minimum lumen diameter (MLD), diameter stenosis (DS) and binary restenosis (BR). The target lesion failure (TLF) was also analyzed.Results: A total of 10 studies, including 5 randomized controlled trials and 5 non-randomized observational studies, with 934 patients were included. Meta-analysis results of angiographic outcomes suggested that DCB group had the less LLL, DS and BR and the higher MLD compared with NDCB group at follow-up (P < 0.05). Meta-analysis results of clinical outcomes suggested that the significant difference in the TLR, MI and CD between DCB group and NDCB group has not been found yet (P > 0.05). However, the MACE of DCB group was significantly less than that of NDCB group at 9-month follow-up [OR = 0.21, 95%CI (0.05, 0.84), P = 0.03] and 12-month follow-up [OR = 0.45, 95%CI (0.22, 0.90), P = 0.02]. In addition, there was no significant difference in TLF between DCB group and NDCB group (P > 0.05).Conclusions: DCB had great effect in side branch protection for de novo CBL at short and medium-term follow-up with no reduction in the procedural success rate.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=267426, PROSPERO [Identifier: CRD42021267426].

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of Drug-Coated Balloon in Side Branch Protection for de novo Coronary Bifurcation Lesions: A Systematic Review and Meta-Analysis

Zheng

Wang

et al. 2021

Front. Cardiovasc. Med.

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“…11) In fact, clinical outcomes in the LM-LAD crossover stenting strategy were comparable with those in the LAD just proximal stenting strategy for the ostial pLAD-AMI patients. 9) Furthermore, unlike the two stent strategy, 24,25) there would be no additional risk in LMT-LAD crossover stenting (± kissing balloon technique) as compared with conventional stenting.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Clinical Outcomes between the Ostial Versus Non-Ostial Culprit in Proximal Left Anterior Descending Artery Acute Myocardial Infarction

et al. 2019

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Percutaneous coronary interventions to the proximal left anterior descending artery (pLAD)-acute myocardial infarction (AMI) are still challenging, especially in the ostial pLAD. Clinical outcomes of the ostial pLAD-AMI were not well investigated. The aim of the present study was to compare clinical outcomes of the ostial pLAD-AMI with those of the non-ostial pLAD-AMI. The primary endpoint was the major cardiovascular events (MACE), defined as the composite of cardiac death, AMI, stent thrombosis (ST), target lesion revascularization (TLR), and target vessel revascularization (TVR). Between January 2009 and March 2016, a total of 401 pLAD-AMI were included as the study population and were divided into 78 ostial pLAD-AMI (the ostial pLAD group), and 323 non-ostial pLAD-AMI (the non-ostial pLAD group). The median follow-up duration was 414 days. The MACE tended to be higher in the ostial pLAD group (8.0% at 30 days, 19.9% at 400 days) than in the non-ostial pLAD group (4.4% at 30 days, 12.9% at 400 days) without reaching statistical significance (P = 0.087). The prevalence of cardiac death was significantly higher in the ostial pLAD group (6.6% at 30 days, 9.5% at 400 days) as compared with the non-ostial pLAD group (3.1% at 30 days, 4.5% at 400 days) (P = 0.034). There were no significant differences in ST, AMI, TLR, or TVR. We concluded that, as compared with the non-ostial pLAD-AMI, the clinical outcomes of the ostial pLAD-AMI, especially cardiac death, tended to be worse, requiring special attention to the ostial pLAD-AMI.

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“…The causes of thrombus formation and subsequent clinical events after coronary stent implantation are considered to be the accumulation of unfavorable factors in patient (eg, diabetes and hereditary drug withdrawal), procedural (eg, suboptimal stenting), device (eg, metal and polymer), lesion (eg, residual thrombus and lipid‐rich plaque), and pharmacological responses to antiplatelet drugs . Renewed technologies in G2‐DES such as biocompatible polymers, improved drug‐eluting kinetics, thinner struts, and a well‐designed platform with better conformability may contribute to the reduction of thrombus formation and clinical events compared with first‐generation DES and BMS .…”

Section: Discussionmentioning

confidence: 99%

Vascular response and intrastent thrombus in the early phase after drug‐eluting versus bare‐metal stent implantation in patients with ST‐segment elevation myocardial infarction: An observational, single‐center study

Sato

Minami

Shimohama

et al. 2018

Health Science Reports

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Background and ObjectivesSecond‐generation drug‐eluting stents (G2‐DES) are associated with a lower rate of acute and subacute stent thrombosis compared with bare‐metal stent (BMS) in the setting of ST‐segment elevation myocardial infarction (STEMI). In this study, our aim was to compare the vascular response and thrombus burden between G2‐DES and BMS in early‐phase STEMI.MethodsBetween May 2010 and August 2014, a total of 41 STEMI patients treated by either G2‐DES (n = 26; everolimus‐eluting stent [EES]: n = 15, zotarolimus‐eluting stent [ZES]: n = 11) or BMS (n = 15) and, with multivessel disease requiring additional percutaneous coronary intervention (PCI), were prospectively enrolled. Optical coherence tomography (OCT) imaging was performed at 1 month after stent implantation.ResultsBaseline clinical characteristics, except for age (61.5 ± 9.3 vs 69.3 ± 9.8, P = 0.01, t test), were comparable between patients with drug‐eluting stent (DES) and BMS. The incidence of residual thrombus after the stent implantation for STEMI was comparable between DES and BMS (7.7% vs 6.7%, P = 0.88, χ 2 test). At 1 month, thrombus burden, defined as the mean thrombus area divided by the mean lumen area, was significantly smaller with DES than with BMS (median interquartile range (IQR), 1.2 (0.0, 1.0) vs 1.2 (0.0, 2.2), P = 0.04, Mann‐Whitney U test), despite a similar percentage of malapposed (median (IQR), 6.2 (2.4, 9.0) vs 2.6 (0.0, 5.8)%, P = 0.07, Mann‐Whitney U test) or uncovered struts (median (IQR), 6.8 (1.8, 13.1) vs 6.14 (2.8, 18.5)%, P = 0.45, Mann‐Whitney U test). No significant difference in thrombus burden was observed between EES and ZES.ConclusionsThrombus burden was significantly smaller with DES than with BMS at 1‐month follow‐up in STEMI cases, although the percentage of malapposed or uncovered struts was similar between the groups. This may partly explain the lower rate of acute and subacute stent thrombosis in G2‐DES that has previously been reported in the literature.

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Definite stent thrombosis after drug‐eluting stent implantation in coronary bifurcation lesions: A meta‐analysis of 3,107 patients from 14 randomized trials

Abstract: Early definite ST is reduced when a SS strategy is used in bifurcation lesions.

Cited by 11 publications

References 69 publications

Effect of Drug-Coated Balloon in Side Branch Protection for de novo Coronary Bifurcation Lesions: A Systematic Review and Meta-Analysis

Effect of Drug-Coated Balloon in Side Branch Protection for de novo Coronary Bifurcation Lesions: A Systematic Review and Meta-Analysis

Comparison of Clinical Outcomes between the Ostial Versus Non-Ostial Culprit in Proximal Left Anterior Descending Artery Acute Myocardial Infarction

Vascular response and intrastent thrombus in the early phase after drug‐eluting versus bare‐metal stent implantation in patients with ST‐segment elevation myocardial infarction: An observational, single‐center study

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