Simple versus complex stenting strategy for coronary artery bifurcation lesions in the drug-eluting stent era: a meta-analysis of randomised trials
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Correspondence to Professor Junbo Ge, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China;
- Accepted 21 July 2009
- Published Online First 29 July 2009
Background: Coronary bifurcation lesions remain a challenge for interventional cardiologists and the optimal stenting strategy has not been established in the current drug-eluting stent (DES) era. This study compared two strategies for DES treatment of coronary bifurcation lesions: a simple stenting approach (stenting only the main vessel (MV) and provisional stenting of the side branch (SB) only when bailout of the SB is necessary) versus a complex stenting approach (routinely stenting not only MV but also SB).
Methods: Data sources included PubMed and conference proceedings. Prespecified criteria were met by five randomised studies comparing simple stenting strategy versus complex stenting strategy in 1553 patients with coronary bifurcation lesions. Studies reported the clinical and angiographic outcomes of efficacy and safety during a minimum of 6 months.
Results: The risks of follow-up myocardial infarction (MI) (relative ratio (RR) 0.54, 95% confidence interval (CI) 0.37 to 0.78, p = 0.001) and early (in-hospital or 30-day) MI (RR 0.52, 95% CI 0.35 to 0.78, p = 0.002) were markedly lower in patients treated with the simple strategy compared to the complex strategy. There were no significant differences between the two different strategies with respect to the rates of cardiac death (RR 0.68, 95% CI 0.21 to 2.25, p = 0.53), target lesion revascularisation (TLR) (RR 0.93, 95% CI 0.62 to 1.41, p = 0.74) or definite stent thrombosis (ST) (RR 0.50, 95% CI 0.19 to 1.32, p = 0.16). The restenosis risk of MV and SB did not differ between the simple strategy group and the complex strategy group (RR 1.15, 95% CI 0.66 to 2.00, p = 0.63 and RR 1.12, 95% CI 0.80 to 1.57, p = 0.50, respectively).
Conclusions: Compared to the complex strategy for DES treatment of coronary bifurcation lesions, the simple strategy was associated with a lower risk of early MI and a similar rate of angiographic restenosis. Since the complex strategy could not improve the clinical or angiographic outcome, the simple strategy can be recommended as a preferred bifurcation stenting technique in the DES era.
Funding This study was supported by the Young Scientific “Phosphor” Fund from the Shanghai Science and Technology Development (No 08QA14019).
Competing interests None.
Provenance and Peer review Not commissioned; externally peer reviewed.