Abstract

Objective: To 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 (stenting both MV and SB).

Methods: Data sources included PubMed and conference proceedings. Prespecified criteria were met by 5 randomized studies comparing simple stenting strategy versus complex stenting strategy in 1,553 patients with coronary bifurcation lesions.

Results: The risks of follow up myocardial infarction (MI) (relative ratio [RR] 0.51,P < 0.001) and early (in hospital or 30 day) MI (RR 0.50, P = 0.001) were markedly lower in patients treated with the simple strategy compared to the complex strategy. There were no differences between two different strategies with respect to the rates of cardiac death (RR 0.68, P = 0.53), target lesion revascularization (TLR) (RR 0.93, P = 0.74) or definite stent thrombosis (ST) (RR 0.50, P = 0.16). The restenosis risk of MV and SB did not differ between the simple strategy group and the complex strategy group (RR 1.05, P = 0.85 and RR 1.12, 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 DES era.