Meta-Analysis Comparing Outcomes With Bifurcation Percutaneous Coronary Intervention Techniques

Elbadawi, Ayman; Shnoda, Mina; Dang, Alexander; Gad, Mohamed M.; Abdelazeem, Mohamed; Saad, Marwan; Salama, Amr; Sharma, Alok; Gilani, Syed Amir; Latib, Azeem; Rab, Tanveer; Elgendy, Islam Y.; Abbott, J. Dawn

doi:10.1016/j.amjcard.2021.10.048

Cited by 15 publications

(12 citation statements)

References 32 publications

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“…To our knowledge, this is the first study to reveal that different stent strategies in the twostent technique may be associated with clinical outcomes in patients with coronary bifurcation lesions. Consistent with this study, a meta-analysis of various randomized controlled trials on coronary bifurcation stent strategies reported that the TLR rate of the T-stent or TAP technique was higher than that of other techniques (16). In the DEFINITION II trial, which included 35% of patients with DM, the double kissing crush technique had a 1-year TLR rate, superior to that of the provisional stent group (14.5 %) using the T-stent or TAP technique for bailout stenting (17).…”

Section: Discussionsupporting

confidence: 71%

Bifurcation strategies using second-generation drug-eluting stents on clinical outcomes in diabetic patients

Cha

Hong

Kim

et al. 2022

Front. Cardiovasc. Med.

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BackgroundDiabetes mellitus (DM) is a critical risk factor for the pathogenesis and progression of coronary artery disease, with a higher prevalence of complex coronary artery disease, including bifurcation lesions. This study aimed to elucidate the optimal stenting strategy for coronary bifurcation lesions in patients with DM.MethodsA total of 905 patients with DM and bifurcation lesions treated with second-generation drug-eluting stents (DES) from a multicenter retrospective patient cohort were analyzed. The primary outcome was the 5-year incidence of target lesion failure (TLF), which was defined as a composite of cardiac death, target vessel myocardial infarction, and target lesion revascularization.ResultsAmong all patients with DM with significant bifurcation lesions, 729 (80.6%) and 176 (19.4%) were treated with one- and two-stent strategies, respectively. TLF incidence differed according to the stenting strategy during the mean follow-up of 42 ± 20 months. Among the stent strategies, T- and V-stents were associated with a higher TLF incidence than one-stent strategy (24.0 vs. 7.3%, p < 0.001), whereas no difference was observed in TLF between the one-stent strategy and crush or culotte technique (7.3 vs. 5.9%, p = 0.645). The T- or V-stent technique was an independent predictor of TLF in multivariate analysis (hazard ratio, 3.592; 95% confidence interval, 2.117–6.095; p < 0.001). Chronic kidney disease, reduced left ventricular ejection fraction, and left main bifurcation were independent predictors of TLF in patients with DM.ConclusionT- or V-stenting in patients with DM resulted in increased cardiovascular events after second-generation DES implantation.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/NCT03068494?term=03068494&draw=2&rank=1, identifier: NCT03068494.

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Section: Discussionsupporting

confidence: 71%

Bifurcation strategies using second-generation drug-eluting stents on clinical outcomes in diabetic patients

Cha

Hong

Kim

et al. 2022

Front. Cardiovasc. Med.

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“…[4] A recent meta-analysis including only randomized controlled trials reported no significant difference between 1-stent and 2-stent strategies. [8] The most recent randomized multicenter trial confirmed this result, indicating comparable primary and secondary outcomes in the 1-stent and 2-stent groups. [5] A definition for complex bifurcation lesions in the distal LMCA has been raised, including the variability of SB, and applied in PCI technique selection.…”

Section: Discussionmentioning

confidence: 78%

“…[7] However, parameters such as the lesion length and diameter of the SB could have a significant impact on technique selection and major cardiac events (MACEs). [8,9] In this meta-analysis, we reviewed existing randomized controlled trials comparing clinical outcomes after PCI with bifurcation lesions, providing evidence for bifurcation PCI technique selection and its influencing factors.…”

Section: What Are the Clinical Implications?mentioning

confidence: 99%

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Impact of Side Branch Lesion Length on Clinical Outcome after Coronary Stenting Techniques in Patients with Coronary Artery Bifurcation Disease: A Meta-Analysis

Kan

Luo

Wang

et al. 2022

Cardiology Discovery

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Objective: The optimal percutaneous coronary intervention (PCI) technique for bifurcation lesions remains controversial, especially considering the variability of the side branch (SB). A provisional stenting technique is currently recommended in most cases. This meta-analysis aimed to compare outcomes of different bifurcation PCI strategies, clarifying their scope of application.Methods: Randomized controlled trials comparing PCI strategies for coronary bifurcation lesions were systematically retrieved from PubMed, Cochrane, Web of Science, and EBSCO literature databases without limitations on published date or language. Major adverse cardiovascular events (MACEs) were stipulated as main outcomes. Secondary outcomes of interest were all-cause mortality, cardiovascular mortality, target lesion revascularization (TLR), target vessel revascularization, myocardial infarction (MI), and stent thrombosis. Both pooled analysis and sub-group analysis were performed.Results: Twenty-three randomized controlled trials with 6380 participants were included. Eighteen studies compared the provisional strategy with 2-stent approaches. No significant difference in MACEs (relative risk (RR), 1.16; 95% confidence interval (CI), 0.90-1.48; I 2 = 62%) was found between 1-stent and 2-stent techniques. However, when SB lesion length was used as the separation condition, the 2-stent strategy was associated with fewer MACEs (RR, 1.87; 95% CI, 1.46-2.41; I 2 = 70%), TLRs (RR, 2.13; 95% CI, 1.50-3.02; I 2 = 59%), and MIs (RR, 2.17; 95% CI, 1.19-3.95; I 2 = 52%) than the provisional strategy in those where SB lesions measured >10 mm long.Conclusions: In the current work, there was no significant difference between 1-stent and 2-stent techniques in terms of MACEs or secondary outcomes. However, 2-stent approaches have clinical advantages over the provisional strategy in bifurcation when the SB lesion length is >10 mm due to fewer cases of TLR and MI.

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“…A recent meta-analysis showed that there was no difference in the risk for MACE up to 3 years between 1-and 2-stent approaches for PCI of bifurcation lesions. 14 The methodological foundation of this approach lies in the accuracy of outcome predictions for each modality of treatment, allowing personalized and individual predictions of the benefit of one treatment over another. 5,8 In the present study, the SS-2020 formally identified a cohort composed of 22.7% of patients in the randomized population who had bifurcation lesions and had a risk difference of <0 (ARD # 0%) in mortality between PCI and CABG (Central Illustration).…”

Section: Impact Of Bifurcation Lesions On All-causementioning

confidence: 99%

Predicted and Observed Mortality at 10 Years in Patients With Bifurcation Lesions in the SYNTAX Trial

Ninomiya

Serruys

Garg

et al. 2022

JACC: Cardiovascular Interventions

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Meta-Analysis Comparing Outcomes With Bifurcation Percutaneous Coronary Intervention Techniques

Cited by 15 publications

References 32 publications

Bifurcation strategies using second-generation drug-eluting stents on clinical outcomes in diabetic patients

Bifurcation strategies using second-generation drug-eluting stents on clinical outcomes in diabetic patients

Impact of Side Branch Lesion Length on Clinical Outcome after Coronary Stenting Techniques in Patients with Coronary Artery Bifurcation Disease: A Meta-Analysis

Predicted and Observed Mortality at 10 Years in Patients With Bifurcation Lesions in the SYNTAX Trial

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