Provisional vs. complex stenting strategy for coronary bifurcation lesions: meta-analysis of randomized trials

To assess the optimal percutaneous coronary intervention (PCI) approach for coronary artery bifurcation lesions (CBL), we conducted a meta-analysis of randomized trials comparing provisional stenting (PS) to complex stenting strategy (CS).

PubMed, Cochrane Register of Controlled Trials, conference proceedings, and internet-based resources of clinical trials.

Six randomized trials comparing the PS to the CS approach for CBL with a total of 1,641 patients met the selection criteria for meta-analysis. There was no difference in the clinical profile between the two groups. No significant heterogeneity was found across trials. There was no difference in the reference vessel diameter of the main vessel (MV) (2.73 +/- 0.41 CS; 2.7 +/- 0.44 PS; p = 0.77) and side branch (SB) (2.31 +/- 0.33 CS; 2.27 +/- 0.34 PS; p = 0.30).There was no difference in the primary clinical outcome of major adverse cardiovascular events (MACE) between the two approaches (12.6% vs. 9.6%; relative risk [RR] 1.23, 95% CI, 0.91-1.68; p = 0.18). Similarly, no differences in other clinical endpoints including death (1% vs. 1.1%, RR 0.93, 95% CI, 0.37-;2.33; p = 0.87), target lesion revascularization (TLR) (6% vs. 5.3%, RR 1.10, 95% CI, 0.73-1.64; p = 0.66), stent thrombosis (ST) (1.8% vs. 0.8%, RR 1.60, 95% CI, 0.65-3.91; p = 0.30), MV restenosis (4.9% vs. 5%; RR 0.74, 95% CI, 0.40-1.38; p = 0.34) and SB restenosis (13.8% vs. 13.8%; RR 1.00, 95% CI, 0.65-1.54); p = 0.99] were observed at a mean follow up of 10 months and a mean angiographic follow up of 7 months. Myocardial infarction (MI) was, however, significantly higher in the CS vs. the PS group (6.8% vs. 3.6%, RR 1.71, 95% CI, 1.02-2.88; p = 0.04).

A CS strategy for CBL had a significantly higher risk of MI compared to a PS strategy. Rates of death, ST, restenosis and TLR were similar.