Elsevier

The American Journal of Cardiology

Volume 165, 15 February 2022, Pages 37-45
The American Journal of Cardiology

Meta-Analysis Comparing Outcomes With Bifurcation Percutaneous Coronary Intervention Techniques

https://doi.org/10.1016/j.amjcard.2021.10.048Get rights and content

There have been mixed results regarding the efficacy and safety of various percutaneous coronary intervention bifurcation techniques. An electronic search of Medline, Scopus, and Cochrane databases was performed for randomized controlled trials that compared the outcomes of any bifurcation techniques. We conducted a pairwise meta-analysis comparing the 1-stent versus 2-stent bifurcation approach, and a network meta-analysis comparing the different bifurcation techniques. The primary outcome was major adverse cardiac events (MACEs).

The analysis included 22 randomized trials with 6,359 patients. At a weighted follow-up of 25.9 months, there was no difference in MACE between 1-stent versus 2-stent approaches (risk ratio [RR] 1.20, 95% confidence interval [CI] 0.92 to 1.56). Exploratory analysis suggested a higher risk of MACE with a 1-stent approach in studies using second-generation drug-eluting stents, if side branch lesion length ≥10 mm, and when final kissing balloon was used. There was no difference between 1-stent versus 2-stent approaches in all-cause mortality (RR 0.95, 95% CI 0.69 to 1.30), cardiovascular mortality (RR 1.07, 95% CI 0.68 to 1.68), target vessel revascularization (TVR) (RR 1.22, 95% CI 0.90 to 1.65), myocardial infarction (MI) (RR 1.04, 95% CI 0.69 to 1.56) or stent thrombosis (RR 1.10, 95% CI 0.68 to 1.78). Network meta-analysis demonstrated that double kissing crush technique was associated with lower MACE, MI, TVR, and target lesion revascularization, whereas culotte technique was associated with higher rates of stent thrombosis. In this meta-analysis of randomized trials, we found no difference between 1-stent versus 2-stent bifurcation percutaneous coronary intervention approaches in the risk of MACE during long-term follow-up. Among the various bifurcation techniques, double kissing crush technique was associated with lower rates of MACE, target lesion revascularization, TVR, and MI.

Section snippets

Methods

A computerized search of Medline, Scopus, and Cochrane databases was performed without language restriction through January 2021, using the terms “percutaneous coronary intervention,” “PCI” and “bifurcation” separately and in combination to identify randomized clinical trials that evaluated the outcomes of various bifurcation PCI techniques. We screened the bibliographies of the retrieved studies and ClinicalTrials.gov to identify any relevant studies not retrieved through the initial search.

Results

The study selection process is outlined in Figure 1. The final analysis included 22 randomized studies with a total of 6,359 patients.4,5,7,12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30 The included studies analyzed the following bifurcation techniques: PS (n = 2,171), T/TAP (n = 497), crush (n = 905), culotte (n = 873), DK-crush (n = 851) and group with mixed 2-stent bifurcation techniques (n = 1,062) (Supplementary Table 1). The weighted mean follow-up was

Discussion

In this meta-analysis of 22 randomized clinical trials including 6,735 patients, we evaluated the efficacy and safety of various bifurcation PCI techniques. The principal findings of this analysis were: (1) there was no significant difference between 1-stent versus 2-stent approaches in MACE, all-cause mortality, cardiovascular mortality, acute MI, TVR, TLR, and stent thrombosis at a mean follow-up of ∼26 months; (2) exploratory analysis suggested a higher risk of MACE with 1-stent compared

Disclosures

Dr. Latib is a consultant and/or on the advisory board of Medtronic, Abbott, Boston Scientific, and Philips. Dr. Elgendy has disclosures unrelated to this manuscript content including receiving research grants from Caladrius Biosciences, Inc. Dr. Abbott is a consultant for Philips and Boston Scientific and has research funding from Abbott, Biosensors, and Sinomed. The other authors have no conflicts of interest to declare.

Funding

None.

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