Systematic Review and Network Meta-Analysis Comparing Bifurcation Techniques for Percutaneous Coronary Intervention

Area of Science:

• Interventional Cardiology
• Cardiovascular Research
• Medical Technology Assessment

Background:

• Bifurcation lesions are complex, comprising 20% of percutaneous coronary interventions.
• These lesions are linked to reduced procedural success and increased restenosis rates.
• An optimal technique for treating bifurcation lesions remains undetermined.

Purpose of the Study:

• To compare the efficacy and safety of various bifurcation stenting techniques.
• To identify the most effective strategy for percutaneous coronary interventions in bifurcation lesions.
• To evaluate outcomes including mortality, major adverse cardiac events, and revascularization.

Main Methods:

• Extensive literature search of randomized clinical trials on bifurcation stenting techniques.
• Conventional meta-analysis and frequentist/Bayesian network meta-analyses were performed.
• Data from 8318 patients across 29 trials were analyzed for specific outcomes.

Main Results:

• No significant differences between two-stent techniques and provisional stenting in overall mortality or major adverse cardiac events.
• Double kissing crush demonstrated significantly lower cardiac death, major adverse cardiac events, myocardial infarction, and stent thrombosis versus provisional stenting.
• Double kissing crush outperformed other two-stent techniques (e.g., T-stent, culotte) and provisional stenting.

Conclusions:

• The double kissing crush technique offers superior outcomes compared to provisional stenting for bifurcation lesions.
• This technique is also more effective than other two-stent approaches.
• A two-stent strategy, specifically double kissing crush, is advantageous for complex side branch lesions (≥10 mm).