Systematic Review and Network Meta‐Analysis Comparing Bifurcation Techniques for Percutaneous Coronary Intervention

Abstract

Background Bifurcation lesions account for 20% of all percutaneous coronary interventions and represent a complex subset which are associated with lower procedural success and higher rates of restenosis. The ideal bifurcation technique, however, remains elusive. Methods and Results Extensive search of the literature was performed to pull data from randomized clinical trials that met predetermined inclusion criteria. Conventional meta‐analysis produced pooled relative risk (RR) and 95% CI of 2‐stent technique versus provisional stent on prespecified outcomes. Both frequentist and Bayesian network meta‐analyses were performed to compare bifurcation techniques. A total of 8318 patients were included from 29 randomized clinical trials. Conventional meta‐analysis showed no significant differences in all‐cause mortality, cardiac death, major adverse cardiac events, myocardial infarction, stent thrombosis, target lesion revascularization, and target vessel revascularization between 2‐stent techniques and provisional stenting. Frequentist network meta‐analysis revealed that double kissing crush was associated with lower cardiac death (RR, 0.57; 95% CI, 0.38–0.84), major adverse cardiac events (RR, 0.50; 95% CI, 0.39–0.64), myocardial infarction (RR, 0.60; 95% CI, 0.39–0.90), stent thrombosis (RR, 0.50; 95% CI, 0.28–0.88), target lesion revascularization, and target vessel revascularization when compared with provisional stenting. Double kissing crush was also superior to other 2‐stent techniques, including T‐stent or T and protrusion, dedicated bifurcation stent, and culotte. Conclusions Double kissing crush was associated with lower risk of cardiac death, major adverse cardiac events, myocardial infarction, stent thrombosis, target lesion revascularization, and target vessel revascularization compared with provisional stenting and was superior to other 2‐stent techniques. Superiority of 2‐stent strategy over provisional stenting was observed in subgroup meta‐analysis stratified to side branch lesion length ≥10 mm.

Clinical Outcomes Following Bifurcation Techniques for Percutaneous Coronary Intervention

“…They found that the two-stent strategy was not superior to provisional stenting except when the lesion length of the side branch is greater than 10 mm. In addition, of all the 2-stent techniques, they found that the double kissing crush technique was associated with lower risk of cardiac death, major adverse cardiac events, MI, stent thrombosis, TVR, and TLR [ 7 ]. Another meta-analysis conducted by Crimi and colleagues looked at 26 randomized clinical trials and found that the double kissing crush technique was associated with lower cardiac death, target vessel MI, stent thrombosis, TLR, and TVR [ 8 ].…”

Left Main Coronary Artery Disease—Current Management and Future Perspectives

“…Firstly, it is noteworthy that an earlier DKCRUSH-III study which focused on differences in clinical outcome between DK crush compared with culotte in distal LMCAD proved that at three years culotte stenting was associated with significantly increased rates of MACCE and stent thrombosis (ST) [ 117 ]. Moreover, the most recent network meta-analysis comparing bifurcation techniques that included 8318 patients from 29 RCTs reported that DK crush was superior to PS and other two-stent techniques [ 118 ]. Yet, in EBC MAIN culotte was the most common, and, on the contrary, DK crush was the least common technique used in a two-stent approach (53% and 5% for culotte and DK crush, respectively).…”

Anti-racist strategies for clinical and translational research: Design, implementation, and lessons learned from a new course

“…Ten were published by a student with a faculty appointment [34][35][36][37][38][39][40][41][42][43]. Overall, there were 3 case reports [34,44,45], one case series [46], 2 editorials [41,43], 2 letters [37,47], 2 review articles [48,49], 7 systematic reviews [35,36,[38][39][40]42,50], 2 retrospective cohort studies [51,52], an evaluation of mobile health applications [53], and a medical education report. [54] One case report noted the subject's race, without further comment [44].…”