PT  - JOURNAL ARTICLE
AU  - Ramez Nairooz
AU  - Marwan Saad
AU  - Islam Y Elgendy
AU  - Ahmed N Mahmoud
AU  - Fuad Habash
AU  - Partha Sardar
AU  - David Anderson
AU  - David M Shavelle
AU  - J Dawn Abbott
TI  - Long-term outcomes of provisional stenting compared with a two-stent strategy for bifurcation lesions: a meta-analysis of randomised trials
AID  - 10.1136/heartjnl-2016-310929
DP  - 2017 Mar 17
TA  - Heart
PG  - heartjnl-2016-310929
4099  - http://heart.bmj.com/content/early/2017/03/16/heartjnl-2016-310929.short
4100  - http://heart.bmj.com/content/early/2017/03/16/heartjnl-2016-310929.full
AB  - 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.