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Original research article
Long-term outcomes of provisional stenting compared with a two-stent strategy for bifurcation lesions: a meta-analysis of randomised trials
  1. Ramez Nairooz1,
  2. Marwan Saad1,
  3. Islam Y Elgendy2,
  4. Ahmed N Mahmoud2,
  5. Fuad Habash3,
  6. Partha Sardar4,
  7. David Anderson2,
  8. David M Shavelle5,
  9. J Dawn Abbott6
  1. 1Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
  2. 2Division of Cardiology, University of Florida, Gainesville, Florida, USA
  3. 3Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
  4. 4Division of Cardiology, University of Utah, Salt Lake City, Utah, USA
  5. 5Division of Cardiology, University of Southern California, Los Angeles, California, USA
  6. 6Division of Cardiology, Brown University, Providence, Rhode Island, USA
  1. Correspondence to Dr J Dawn Abbott, Associate Professor of Medicine, Warren Alpert Medical School, Brown University, 593 Eddy Street, RIH APC814, Providence, RI 02903, USA; jabbott{at}lifespan.org

Abstract

Background The optimal interventional technique for addressing coronary bifurcation lesions is debatable. Long-term clinical outcomes with provisional stenting (PS) compared with a two-stent (TS) strategy for bifurcation lesions are scarce. We aim to perform the first meta-analysis of randomised controlled trials (RCTs) to explore long-term outcomes comparing both strategies.

Methods An electronic search was performed for online databases until August 2016 for RCTs comparing PS with TS for bifurcation lesions reporting outcomes at 1 year of follow-up or more. Random effects model risk ratios (RRs) were calculated for outcomes of interest.

Results Eight RCTs with a total of 2778 patients reported long-term clinical outcomes. At mean follow-up of 3.0±1.6 years, PS was associated with lower risk of all-cause mortality (RR=0.66; 95% CI 0.45 to 0.98; p=0.04) compared with TS for bifurcation lesions. No difference was observed with PS compared with TS regarding major adverse cardiac events (MACE), myocardial infarction (MI), target lesion revascularisation (TLR) or stent thrombosis (ST). In a sensitivity analysis limited to trials with follow-up duration ≥3 years, PS was associated with lower risk of all-cause mortality (RR=0.57; 95% CI 0.36 to 0.88; p=0.01), MACE (RR=0.71; 95% CI 0.52 to 0.97; p=0.03) and MI (RR=0.45; 95% CI 0.21 to 0.96; p=0.04) compared with TS, at mean follow-up of 4.6±0.7 years. The risk of TLR and ST remained similar with both strategies (RR=0.81; 95% CI 0.57 to 1.15; p=0.24; and RR=0.75; 95% CI 0.19 to 2.84; p=0.67 respectively). Meta-regression analyses identified increased risk of MACE with PS in patients presenting with acute coronary syndrome (p=0.05).

Conclusion PS may be associated with a long-term mortality benefit compared with a TS strategy for coronary bifurcation lesions.

  • Provisional stenting
  • Bifurcation lesion
  • PCI

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Footnotes

  • Contributors All authors have contributed significantly to this research work and all meet criteria for authorship.

  • Funding JDA received research grant from Abbott Cardiovascular Systems Inc. DS received grant support from Abbott Vascular, AbioMed, Medtronic, NIH, Zoll Medical, St Jude Medical, Speaker's Bureau Maquet and Medtronic.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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