Journal article
Meta-Analysis of Provisional Versus Systematic Double-Stenting Strategy for Left Main Bifurcation Lesions
Cardiovascular revascularization medicine, Vol.45, pp.53-62
12/2022
DOI: 10.1016/j.carrev.2022.07.017
PMID: 35934644
Abstract
We sought to compare the clinical outcomes with provisional versus double-stenting strategy for left main (LM) bifurcation percutaneous coronary intervention (PCI).
Despite two recent randomized controlled trials (RCTs) and several observational reports, the optimal LM bifurcation PCI technique remains controversial.
PubMed, Cochrane Central Register of Controlled-Trials (CENTRAL), Clinicaltrials.gov, International Clinical Trial Registry Platform were leveraged for studies comparing PCI bifurcation techniques for LM coronary lesions using second-generation drug eluting stents (DES). The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes of interest were all-cause mortality, cardiovascular mortality, myocardial infarction (MI), target vessel or lesion revascularization, and stent thrombosis.
Two RCTs and 10 observational studies with 7105 patients were included. Median follow-up duration was 42 months (IQR: 25.7). Double stenting was associated with a trend towards higher incidence of MACE (odds ratio [OR] 1.20; 95 % confidence interval [CI] 0.94 to 1.53) compared with provisional stenting. This was mainly driven by higher rates of target lesion revascularization (TLR) (OR 1.50; 95 % CI 1.07 to 2.11). There were no statistically significant differences in the incidence of all-cause mortality, cardiovascular mortality, MI, or stent thrombosis. On subgroup analysis according to the study type, provisional stenting was associated with lower MACE and TLR in observational studies, but not in RCTs.
For LM bifurcation PCI using second-generation DES, a provisional stenting strategy was associated with a trend towards lower incidence of MACE driven by statistically significant lower rates of TLR, compared with systematic double stenting. These differences were primarily driven by observational studies. Further RCTs are warranted to confirm these findings.
Central illustration: summary of study findings. [Display omitted]
•What is already known about this subject?•► PCI with 2nd Ggeneration DES has emerged as an acceptable revascularization strategy among left main (LM) CAD, as compared with CABG.•► Provisional stenting is the preferred approach for majority of unprotected LM bifurcation patients.•What does this study add?•► Provisional stenting was associated with a trend towards lower occurrence of MACE driven by lower rates of TLR, compared with systematic double stenting for LM bifurcation PCI.•How might this impact on clinical practice?•► Provisional stenting strategy is equivalent to the double stent strategy. Therefore, this technique should no longer be considered as the default strategy for this unique anatomic setting.•► Further RCTs are warranted to investigate further the safety and efficacy of these techniques in left main (LM) bifurcation PCI.
Details
- Title: Subtitle
- Meta-Analysis of Provisional Versus Systematic Double-Stenting Strategy for Left Main Bifurcation Lesions
- Creators
- Omar M. Abdelfattah - Morristown Medical CenterAhmed Radwan - Morristown Medical CenterAhmed Sayed - Ain Shams UniversityAyman Elbadawi - The University of Texas Southwestern Medical CenterLaith A. Derbas - Rush University Medical CenterYehia Saleh - Houston MethodistYousif Ahmad - Yale UniversityAmmar ElJack - Heart Hospital Baylor PlanoAmirali Masoumi - Morristown Medical CenterDimitri Karmpaliotis - Morristown Medical CenterIslam Y. Elgendy - University of KentuckyFernando Alfonso - Hospital Universitario de La Princesa
- Resource Type
- Journal article
- Publication Details
- Cardiovascular revascularization medicine, Vol.45, pp.53-62
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.carrev.2022.07.017
- PMID
- 35934644
- ISSN
- 1553-8389
- eISSN
- 1878-0938
- Number of pages
- 10
- Language
- English
- Date published
- 12/2022
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984755389902771
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