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One- and 3-year outcomes of percutaneous bifurcation left main revascularization with modern drug-eluting stents: a systematic review and meta-analysis

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Abstract

Aims

Optimal percutaneous coronary intervention (PCI) strategy for coronary left main (LM) bifurcation lesions remains controversial. We performed systematic review and meta-analysis comparing one and 3-year clinical outcomes of 1- and 2- stent strategies using modern drug eluting stents (DESs) for revascularization of LM bifurcation disease.

Methods

We systematically identified all investigations published between January 2015 and February 2020 comparing the use of single versus double-stent strategies for the revascularization of LM bifurcation lesions. The primary endpoint was 1- and 3-years all-cause mortality. Secondary outcomes included target lesion revascularization (TLR), target lesion failure (TLF), major adverse cardiovascular vents (MACEs) and cardiovascular (CV) mortality while the tertiary outcome was overall occurrence of stent thrombosis (ST) at 1- and 3-years.

Results

No significant differences were observed between the two groups in terms of all-cause mortality rate both at 1 and 3-year follow-up. Single stent strategy was associated with a significantly lower risk of TLR (OR 0.78, 95% CI 0.62- 0.97, p = 0.03, I2 = 61%) as well as of MACEs (OR 0.78, 95% CI 0.63–0.97, I2 = 24%) compared to 2-stent strategy. Conversely no significant differences between the two groups were observed in terms of TLF, CV mortality and ST during the same follow-up period.

Conclusions

In patients with LM bifurcation disease, single stent strategy demonstrated lower rate of MACEs and TLR but was not superior to 2-stent strategy in terms of CV mortality, TLF and ST at 1 and 3-year follow-up.

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Author notes

  1. Gianluca Rigatelli and Marco Zuin equally contributed to the manuscript.

Authors and Affiliations

  1. Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Viale tre Martiri, 45100, Rovigo, Italy

    Gianluca Rigatelli & Marco Zuin

  2. University of Ferrara, School of Medicine, Ferrara, Italy

    Marco Zuin

  3. Department of Cardiology, Alexandrovska University Hospital, Sofia, Bulgaria

    Pavel Nikolov, Nyha Mileva & Dobrin Vassilev

Authors
  1. Gianluca Rigatelli
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  2. Marco Zuin
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  3. Pavel Nikolov
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  4. Nyha Mileva
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Correspondence to Gianluca Rigatelli.

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Supplementary file1 Supplementary file 1. PRISM checklist (DOCX 25 kb)

392_2020_1679_MOESM2_ESM.docx

Supplementary file2 Supplementary file 2. Egger’s tests evaluating publication biases among the different outcomes (DOCX 13 kb)

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Rigatelli, G., Zuin, M., Nikolov, P. et al. One- and 3-year outcomes of percutaneous bifurcation left main revascularization with modern drug-eluting stents: a systematic review and meta-analysis. Clin Res Cardiol 110, 1–11 (2021). https://doi.org/10.1007/s00392-020-01679-w

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  • DOI: https://doi.org/10.1007/s00392-020-01679-w

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