Abstract 20049: Double versus Provisional Stent Strategy for Coronary Bifurcation Using Drug-Eluting Stents: A Meta-Analysis of Randomized Controlled Trials
Introduction: Percutaneous coronary intervention (PCI) of coronary artery bifurcation (CAB) has been performed with double stent (DS) strategy or strategy of provision stenting (PS) of side branch. However, the superiority of one strategy over other is not established especially in the era of newer generation drug eluting stenting (DES). To compare the clinical and angiographic outcomes of DS versus PS strategies for CAB lesions, we performed a systematic review and meta-analysis of randomized trials using DES.
Methods: PubMed, Cochrane and Web of Science databases were searched through June 15th 2014 for RCTs comparing DS versus PS strategy for CAB using DES. Both clinical [cardiac mortality, myocardial infarction (MI), definite stent thrombosis (ST), TVR] & angiographic outcomes (binary restenosis rate of >50%, in-stent late loss) were assessed. Study quality, publication bias, heterogeneity were assessed. Random effect model used for data analysis.
Results: Ten RCTs comprising 2585 patients (DS group=1318 PS group=1267) were selected for analysis. Gender (males: DS 78%, PS 77%) & age (DS 63.5, PS 64.3 years) distribution were similar in both groups. Follow up period varied from 6 months to 1 year for all studies. There was no significant difference in overall cardiac mortality (RR 0.87 CI 0.29-2.62, p=0.8) and definite ST (RR: 1.67 CI 0.69-4.07, p=0.25) rates between DS & PS groups. There was a trend towards higher sub-acute (< 30days) definite ST (RR 3.2 p=0.07) in PS group. Overall MI was significantly higher (RR 1.59 CI 1.06-2.39, p=0.02) in PS group along with a significant trend towards early (< 30days) MI (RR 1.7 p=0.06). DS strategy was associated with lower TVR rates (RR 0.53 CI 0.33-0.85, p=0.009) compared to PS group. Angiographic follow up, which was done at 6-9 months showed significantly higher side branch late loss (SMD 0.26mm CI 0.15-0.37 p < 0.001) in the PS group though main branch late loss (SMD 0.07mm CI -0.05 to 0.19 p=0.29) & binary restenosis rate of >50% remained comparable between two groups (MB: p = 0.32, SB: p=0.39).
Conclusion: DS strategy significantly reduces TVR & SB related late loss compared to PS during PCI of CAB using DES. DS is also superior in terms of lower MI rates while cardiac mortality & definite ST are comparable to PS strategy.
Author Disclosures: A. Saurav: None. A.K. Kaja: None. M. Kaushik: None. M. DelCore: None. A.V. Mooss: None. W. Biddle: None.
- © 2014 by American Heart Association, Inc.