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Percutaneous Coronary Intervention Techniques for Bifurcation Disease: Network Meta-analysis Reveals Superiority of Double-Kissing Crush

2019; Elsevier BV; Volume: 36; Issue: 6 Linguagem: Inglês

10.1016/j.cjca.2019.09.002

1916-7075

Gabriele Crimi, Alessandro Mandurino‐Mirizzi, Valeria Gritti, Valeria Scotti, C Strozzi, Annalisa De Silvestri, Claudio Montalto, Ciro Di Giacomo, Fabrizio D’Ascenzo, Alessandra Repetto, Marco Ferlini, Barbara Marinoni, Maurizio Ferrario, Stefano De Servi, Luigi Oltrona Visconti, Catherine Klersy,

Acute Myocardial Infarction Research

Background Provisional T-stenting (PS) is generally recommended to treat patients with coronary bifurcation disease (CBD) percutaneously, but PS may not fit all complex bifurcation anatomies. Therefore, several types of up-front 2-stent techniques have been described. We aimed to identify the best percutaneous coronary intervention (PCI) technique to manage patients with CBD. Methods We systematically reviewed randomized controlled trials (RCTs) including patients undergoing CBD PCI which included several types of PCI techniques—PS, double-kissing (DK) crush, T-stenting and protrusion, culotte, dedicated bifurcation stents, crushing, and T-stenting—and we compared device-oriented clinical events (DOCEs), a composite of cardiac death, target-vessel myocardial infarction, stent thrombosis, and target-lesion or target-vessel revascularization, in a network meta-analysis. We included 26 RCTs, leading to a pooled population of 10,339 patient-years and a total of 1229 DOCEs. Results The DK-crush technique was associated with the lowest DOCE rate, with a relative risk of 0.62 (95% CI 0.42-0.92) compared with the PS technique. DK-crush had the highest probability (model likelihood 90.2%, area under the cumulative ranking curve 98.0%) of being the best technique among those explored to reduce DOCEs in patients receiving CBD PCI. Conclusions When a 2-stent strategy is considered in a patient with CBD, the DK-crush technique reduces DOCEs compared with other bifurcation techniques based on all available RCTs.