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Cardiovascular outcomes associated with crush versus provisional stenting techniques for bifurcation lesions: a
1Institute of Cardiovascular Diseases and Guangxi Key Laboratory Base of Precision Medicine in Cardio-cerebrovascular Disease Control and Prevention and Guangxi Clinical Research Center for Cardio-cerebrovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China. huangfeng7925@163.com.
Insights
Crush stenting significantly reduces major adverse cardiac events and revascularization in coronary bifurcation lesions compared to provisional stenting. This technique offers improved outcomes without increasing mortality or other major complications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Technology
Background:
- Percutaneous coronary intervention (PCI) for coronary artery bifurcation lesions presents unique challenges.
- Optimal intra-procedural techniques are crucial for successful PCI outcomes.
- Comparing different stenting strategies is essential for improving patient care.
Purpose of the Study:
- To systematically compare cardiovascular outcomes after PCI for bifurcation lesions using crush versus provisional stenting.
- To evaluate the efficacy and safety of crush stenting compared to provisional stenting.
- To provide evidence-based insights for interventional cardiologists.
Main Methods:
- A systematic literature search was conducted across major databases (MEDLINE, EMBASE, Cochrane) and ClinicalTrials.gov.
- Included studies compared crush stenting and provisional stenting for coronary bifurcation lesions.
- Key endpoints included major adverse cardiac events, mortality, myocardial infarction, stent thrombosis, and revascularization rates.
Main Results:
- Six studies with 2220 patients (1085 crush, 1135 provisional) were analyzed.
- Crush stenting showed significantly lower rates of major adverse cardiac events (OR: 0.73), target vessel revascularization (OR: 0.62), and target lesion revascularization (OR: 0.62).
- No significant differences were observed in all-cause mortality, cardiac death, myocardial infarction, or stent thrombosis between the techniques.
Conclusions:
- Crush stenting is associated with superior outcomes in terms of reduced MACE and revascularization for coronary bifurcation lesions compared to provisional stenting.
- The crush technique demonstrates a favorable risk-benefit profile, enhancing procedural success.
- These findings support the consideration of crush stenting in specific bifurcation lesion scenarios.
Background:
Percutaneous coronary intervention (PCI) for bifurcation lesions has often been challenging for Interventionists. Application of the correct intra-procedural technique is vital to generate beneficial outcomes after PCI. We aimed to systematically compare the post interventional cardiovascular outcomes which were reported using crush versus provisional stenting techniques for bifurcation lesions.
Methods:
A computerized search was carried out through Medical Literature Analysis and Retrieval System Online, EMBASE, the Cochrane Central and through www.ClinicalTrials.gov for English publications comparing crush versus the provisional stenting techniques for coronary bifurcation lesions during PCI. Major adverse cardiac events, all-cause mortality, cardiac death, myocardial infarction, stent thrombosis, target vessel and target lesion revascularizations were the endpoints in this analysis. Odds ratios (OR) and 95% confidence intervals (CI) were generated during statistical analysis to represent the data.
Results:
Six studies consisting of a total number of 2220 participants (1085 participants were assigned to the crush stenting technique and 1135 participants were assigned to the provisional stenting technique) enrolled between years 2004 and 2016 were included in this analysis. During a follow-up time period from six to sixty months, major adverse cardiac events (OR: 0.73, 95% CI: 0.59-0.91; P = 0.005), target vessel revascularization (OR: 0.62, 95% CI: 0.43-0.89; P = 0.01) and target lesion revascularization (OR: 0.62, 95% CI: 0.45-0.85; P = 0.003) were significantly lower in patients who were assigned to the crush stenting technique. However, all-cause mortality (OR: 0.90, 95% CI: 0.48-1.68; P = 0.74), cardiac death (OR: 0.56, 95% CI: 0.29-1.08; P = 0.08), myocardial infarction (OR: 0.89, 95% CI: 0.62-1.27; P = 0.53) and stent thrombosis (OR: 0.72, 95% CI: 0.36-1.42; P = 0.34) were not significantly different.
Conclusion:
In patients with coronary bifurcation lesions undergoing PCI, crush stenting technique was associated with significantly lower major adverse cardiac events and repeated revascularization without any change in mortality, myocardial infarction and stent thrombosis when compared to the provisional technique showing a benefit of crush over the provisional stenting technique during PCI.
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