E-45 | A Systematic Review and Network Meta-analysis Comparing Bifurcation Techniques for Percutaneous Coronary Intervention (2022)

BackgroundBifurcation 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.MethodsExtensive search of the literature was performed to pull data from randomized clinical trials (RCTs) that met predetermined inclusion criteria. Conventional meta-analysis produced pooled relative risk (RR) and 95% confidence intervals (CI) of two-stent technique versus provisional stent on prespecified outcomes. Both frequentist and Bayesian network meta-analyses were performed to compare bifurcation techniques.ResultsA total of 8,318 patients were included from 29 RCTs. Conventional meta-analysis showed no significant differences in all-cause mortality, cardiac death, major adverse cardiac events (MACE), myocardial infarction (MI), stent thrombosis, target lesion revascularization (TLR), and target vessel revascularization (TVR) between two-stent techniques and provisional stenting. Frequentist network meta-analysis revealed that double kissing (DK) crush was associated with lower cardiac death (RR 0.57; 95% CI 0.38-0.84), MACE (RR 0.50; 95% CI 0.39-0.64), MI (RR 0.60; 95% CI 0.39-0.90), stent thrombosis (RR 0.50; 95% CI 0.28-0.88), TLR, and TVR when compared with provisional stenting. DK crush was also superior to others two-stent techniques, including T/TAP, DBS, and culotte.ConclusionsDK crush was associated with lower risk of cardiac death, MACE, MI, stent thrombosis, TLR, and TVR compared with provisional stenting and was superior to other two-stent techniques. Superiority of two-stent strategy over provisional stenting was observed in subgroup meta-analysis stratified to SB lesion length greater than or equal to 10mm.DisclosuresD. Y. Park Nothing to disclose. S. An Nothing to disclose. N. Jolly Nothing to disclose. S. Attanasio Nothing to disclose. N. Yadav Nothing to disclose. S. V. Rao Nothing to disclose. A. Vij Nothing to disclose. BackgroundBifurcation 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. 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. MethodsExtensive search of the literature was performed to pull data from randomized clinical trials (RCTs) that met predetermined inclusion criteria. Conventional meta-analysis produced pooled relative risk (RR) and 95% confidence intervals (CI) of two-stent technique versus provisional stent on prespecified outcomes. Both frequentist and Bayesian network meta-analyses were performed to compare bifurcation techniques. Extensive search of the literature was performed to pull data from randomized clinical trials (RCTs) that met predetermined inclusion criteria. Conventional meta-analysis produced pooled relative risk (RR) and 95% confidence intervals (CI) of two-stent technique versus provisional stent on prespecified outcomes. Both frequentist and Bayesian network meta-analyses were performed to compare bifurcation techniques. ResultsA total of 8,318 patients were included from 29 RCTs. Conventional meta-analysis showed no significant differences in all-cause mortality, cardiac death, major adverse cardiac events (MACE), myocardial infarction (MI), stent thrombosis, target lesion revascularization (TLR), and target vessel revascularization (TVR) between two-stent techniques and provisional stenting. Frequentist network meta-analysis revealed that double kissing (DK) crush was associated with lower cardiac death (RR 0.57; 95% CI 0.38-0.84), MACE (RR 0.50; 95% CI 0.39-0.64), MI (RR 0.60; 95% CI 0.39-0.90), stent thrombosis (RR 0.50; 95% CI 0.28-0.88), TLR, and TVR when compared with provisional stenting. DK crush was also superior to others two-stent techniques, including T/TAP, DBS, and culotte. A total of 8,318 patients were included from 29 RCTs. Conventional meta-analysis showed no significant differences in all-cause mortality, cardiac death, major adverse cardiac events (MACE), myocardial infarction (MI), stent thrombosis, target lesion revascularization (TLR), and target vessel revascularization (TVR) between two-stent techniques and provisional stenting. Frequentist network meta-analysis revealed that double kissing (DK) crush was associated with lower cardiac death (RR 0.57; 95% CI 0.38-0.84), MACE (RR 0.50; 95% CI 0.39-0.64), MI (RR 0.60; 95% CI 0.39-0.90), stent thrombosis (RR 0.50; 95% CI 0.28-0.88), TLR, and TVR when compared with provisional stenting. DK crush was also superior to others two-stent techniques, including T/TAP, DBS, and culotte. ConclusionsDK crush was associated with lower risk of cardiac death, MACE, MI, stent thrombosis, TLR, and TVR compared with provisional stenting and was superior to other two-stent techniques. Superiority of two-stent strategy over provisional stenting was observed in subgroup meta-analysis stratified to SB lesion length greater than or equal to 10mm. DK crush was associated with lower risk of cardiac death, MACE, MI, stent thrombosis, TLR, and TVR compared with provisional stenting and was superior to other two-stent techniques. Superiority of two-stent strategy over provisional stenting was observed in subgroup meta-analysis stratified to SB lesion length greater than or equal to 10mm.