Purpose: The optimal percutaneous management of patients presenting with coronary bifurcation lesions remain to be defined. Methods: Randomized controlled trial (RCT) comparing different treatments for bifurcation lesions were included. Major Adverse Cardiovascular Events (MACE, a composite end point of death, myocardial infarction, target lesion revascularization [TLR]) was the primary end point, while each single event of the MACE composite endpoint was evaluated separately as Stent Thrombosis (ST). Main analysis included studies evaluating different kind of treatment (provisional, T stenting, crush, culotte and double kissing double crush, DK crush) along with type of implanted stents (BMS, sirolimus and paclitaxel stents defined as first generation DES and Everolimus Eluting Stent [EES]) with or without final kissing balloon (FKB). Results: Provisional strategy was evaluated in eleven studies with first generation DES and FKB (1819 patients) and without FKB in one RCT with 239, in two studies with BMS and FKB (67 patients), in one RCT with BMS and drug eluting balloon (40 patients) and in three studies with EES (408 patients). Crush stenting with first generation DES and FKB was appraised into three studies with 601 patients, T stenting with first generation DES and FKB in one RCT (101 patients), DK crush with first generation DES in 101 patients in one study and with EES in 2 studies with 395 patients and culotte into two studies (215 patients with first generation DES and 209 with EES). Provisional with EES did not result inferior to DK crush with EES (OR 0.58:0.29-1.1), to culotte with EES (OR 1.8: 0.7-4.1) and to crush and T stenting with first generation DES (OR 1.1: 0.4-1.9 and OR 1.2: 0.03-5 respectively). DK crush presented the highest probability of performing bests. About target lesion revascularization, provisional strategy was not inferior to two stent techniques, apart from DK crush which resulted superior (OR 0.42: 0.21-0.87), with the highest probability of performing bests. About stent thrombosis, no strategies performed superior to the others, with provisional with EES with the highest probability of performing bests. Conclusion: Provisional strategy did not perform inferior to two stent techniques, apart from DK crush which resulted more efficacious for target lesion revascularization. Provisional strategy performed best for reducing ST.
Percutaneous treatment of coronary bifurcation: a network meta analysis of randomized controlled trial
PERVERSI, JACOPO;D'ASCENZO, FABRIZIO;QUADRI, Giorgio;GAITA, Fiorenzo
2014-01-01
Abstract
Purpose: The optimal percutaneous management of patients presenting with coronary bifurcation lesions remain to be defined. Methods: Randomized controlled trial (RCT) comparing different treatments for bifurcation lesions were included. Major Adverse Cardiovascular Events (MACE, a composite end point of death, myocardial infarction, target lesion revascularization [TLR]) was the primary end point, while each single event of the MACE composite endpoint was evaluated separately as Stent Thrombosis (ST). Main analysis included studies evaluating different kind of treatment (provisional, T stenting, crush, culotte and double kissing double crush, DK crush) along with type of implanted stents (BMS, sirolimus and paclitaxel stents defined as first generation DES and Everolimus Eluting Stent [EES]) with or without final kissing balloon (FKB). Results: Provisional strategy was evaluated in eleven studies with first generation DES and FKB (1819 patients) and without FKB in one RCT with 239, in two studies with BMS and FKB (67 patients), in one RCT with BMS and drug eluting balloon (40 patients) and in three studies with EES (408 patients). Crush stenting with first generation DES and FKB was appraised into three studies with 601 patients, T stenting with first generation DES and FKB in one RCT (101 patients), DK crush with first generation DES in 101 patients in one study and with EES in 2 studies with 395 patients and culotte into two studies (215 patients with first generation DES and 209 with EES). Provisional with EES did not result inferior to DK crush with EES (OR 0.58:0.29-1.1), to culotte with EES (OR 1.8: 0.7-4.1) and to crush and T stenting with first generation DES (OR 1.1: 0.4-1.9 and OR 1.2: 0.03-5 respectively). DK crush presented the highest probability of performing bests. About target lesion revascularization, provisional strategy was not inferior to two stent techniques, apart from DK crush which resulted superior (OR 0.42: 0.21-0.87), with the highest probability of performing bests. About stent thrombosis, no strategies performed superior to the others, with provisional with EES with the highest probability of performing bests. Conclusion: Provisional strategy did not perform inferior to two stent techniques, apart from DK crush which resulted more efficacious for target lesion revascularization. Provisional strategy performed best for reducing ST.
I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
