Giuseppe Di Gioia1, Jeroen Sonck1, Miroslaw Ferenc2, Shao-Liang Chen3, Iginio Colaiori4, Emanuele Gallinoro4, Takuya Mizukami5, Monika Kodeboina1, Sakura Nagumo5, Danilo Franco6, Jozef Bartunek4, Marc Vanderheyden4, Eric Wyffels4, Bernard De Bruyne4, Jens F Lassen7, Johan Bennett8, Dobrin Vassilev9, Patrick W Serruys10, Goran Stankovic11, Yves Louvard12, Emanuele Barbato6, Carlos Collet13. 1. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Advance Biomedical Sciences, Federico II University, Naples, Italy. 2. Division of Cardiology and Angiology II, University Heart Centre Freiburg, Bad Krozingen, Bad Krozingen, Germany. 3. Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China; Key Laboratory of Cardiovascular and Cerebrovascular Medicine, School of Pharmacy, Nanjing Medical University, Nanjing, China. 4. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium. 5. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Division of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan. 6. Department of Advance Biomedical Sciences, Federico II University, Naples, Italy. 7. Department of Cardiology, Odense University Hospital & University of Southern Denmark, Odense, Denmark. 8. Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium. 9. "Alexandrovska" University Hospital, Sofia, Bulgaria. 10. Department of Cardiology, National University of Ireland, Galway, Ireland. 11. Department for Diagnostic and Catheterization Laboratories, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia. 12. Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France. 13. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium. Electronic address: carloscollet@gmail.com.
Abstract
OBJECTIVES: The aim of this study was to compare clinical outcomes of different bifurcation percutaneous coronary intervention (PCI) techniques. BACKGROUND: Despite several randomized trials, the optimal PCI technique for bifurcation lesions remains a matter of debate. Provisional stenting has been recommended as the default technique for most bifurcation lesions. Emerging data support double-kissing crush (DK-crush) as a 2-stent technique. METHODS: PubMed and Scopus were searched for randomized controlled trials comparing PCI bifurcation techniques for coronary bifurcation lesions. Outcomes of interest were major adverse cardiovascular events (MACE). Secondary outcomes of interest were cardiac death, myocardial infarction, target vessel or lesion revascularization, and stent thrombosis. Summary odds ratios (ORs) were estimated using Bayesian network meta-analysis. RESULTS: Twenty-one randomized controlled trials including 5,711 patients treated using 5 bifurcation PCI techniques were included. Investigated techniques were provisional stenting, T stenting/T and protrusion, crush, culotte, and DK-crush. Median follow-up duration was 12 months (interquartile range: 9 to 36 months). When all techniques were considered, patients treated using the DK-crush technique had less occurrence of MACE (OR: 0.39; 95% credible interval: 0.26 to 0.55) compared with those treated using provisional stenting, driven by a reduction in target lesion revascularization (OR: 0.36; 95% credible interval: 0.22 to 0.57). No differences were found in cardiac death, myocardial infarction, or stent thrombosis among analyzed PCI techniques. No differences in MACE were observed among provisional stenting, culotte, T stenting/T and protrusion, and crush. In non-left main bifurcations, DK-crush reduced MACE (OR: 0.42; 95% credible interval: 0.24 to 0.66). CONCLUSIONS: In this network meta-analysis, DK-crush was associated with fewer MACE, driven by lower rates of repeat revascularization, whereas no significant differences among techniques were observed for cardiac death, myocardial infarction, and stent thrombosis. A clinical benefit of 2-stent techniques was observed over provisional stenting in bifurcation with side branch lesion length ≥10 mm.
OBJECTIVES: The aim of this study was to compare clinical outcomes of different bifurcation percutaneous coronary intervention (PCI) techniques. BACKGROUND: Despite several randomized trials, the optimal PCI technique for bifurcation lesions remains a matter of debate. Provisional stenting has been recommended as the default technique for most bifurcation lesions. Emerging data support double-kissing crush (DK-crush) as a 2-stent technique. METHODS: PubMed and Scopus were searched for randomized controlled trials comparing PCI bifurcation techniques for coronary bifurcation lesions. Outcomes of interest were major adverse cardiovascular events (MACE). Secondary outcomes of interest were cardiac death, myocardial infarction, target vessel or lesion revascularization, and stent thrombosis. Summary odds ratios (ORs) were estimated using Bayesian network meta-analysis. RESULTS: Twenty-one randomized controlled trials including 5,711 patients treated using 5 bifurcation PCI techniques were included. Investigated techniques were provisional stenting, T stenting/T and protrusion, crush, culotte, and DK-crush. Median follow-up duration was 12 months (interquartile range: 9 to 36 months). When all techniques were considered, patients treated using the DK-crush technique had less occurrence of MACE (OR: 0.39; 95% credible interval: 0.26 to 0.55) compared with those treated using provisional stenting, driven by a reduction in target lesion revascularization (OR: 0.36; 95% credible interval: 0.22 to 0.57). No differences were found in cardiac death, myocardial infarction, or stent thrombosis among analyzed PCI techniques. No differences in MACE were observed among provisional stenting, culotte, T stenting/T and protrusion, and crush. In non-left main bifurcations, DK-crush reduced MACE (OR: 0.42; 95% credible interval: 0.24 to 0.66). CONCLUSIONS: In this network meta-analysis, DK-crush was associated with fewer MACE, driven by lower rates of repeat revascularization, whereas no significant differences among techniques were observed for cardiac death, myocardial infarction, and stent thrombosis. A clinical benefit of 2-stent techniques was observed over provisional stenting in bifurcation with side branch lesion length ≥10 mm.
Authors: Ilias Nikolakopoulos; Evangelia Vemmou; Judit Karacsonyi; Lorenzo Azzalini; Brian A Bergmark; Yiannis S Chatzizisis; Allison B Hall; Jason Wollmuth; Kevin Croce; Hani Jneid; Bavana V Rangan; M Nicholas Burke; Emmanouil S Brilakis Journal: J Invasive Cardiol Date: 2022-01 Impact factor: 2.022
Authors: Mohamed O Mohamed; Pablo Lamellas; Ariel Roguin; Rohit M Oemrawsingh; Alexander J J Ijsselmuiden; Helen Routledge; Frank van Leeuwen; Roxane Debrus; Marco Roffi; Mamas A Mamas Journal: J Am Heart Assoc Date: 2022-08-24 Impact factor: 6.106