Dedicated Bifurcation Stents vs. Regular Drug-Eluting Stents in Coronary Bifurcation Treatment: A Systematic Review and Meta-Analysis of 1-Year and 4-Year Outcomes, Including Left Main and Non-Left Main Subgroup Comparisons

Background: Dedicated bifurcation stents (DBS) were developed to overcome the limitations of conventional drug-eluting stents (DES) in percutaneous coronary intervention (PCI) for bifurcation lesions, but their clinical benefit remains uncertain. Methods: We conducted a systematic review and meta-analysis of randomized trials comparing DBS with contemporary DES in bifurcation PCI. Primary outcomes included all-cause death, myocardial infarction (MI), and target lesion revascularization (TLR) at 1 and 4 years. Subgroup analyses were performed for left main (LM) and non-LM bifurcations. Results: Ten trials involving approximately 2500 patients were analyzed. At 1 year, DBS and DES demonstrated similar rates of all-cause death (RR 1.12, 95% CI 0.81-1.55), MI (RR 0.80, 95% CI 0.38-1.69), and TLR (RR 1.23, 95% CI 0.79-1.90). At 4 years, results remained consistent: all-cause death (RR 1.10, 95% CI 0.75-1.60), MI (RR 0.66, 95% CI 0.29-1.49), and TLR (RR 1.29, 95% CI 0.86-1.94). No significant differences were observed between LM and non-LM subgroups, and no excess in late stent thrombosis was detected. Conclusions: DBS are safe and provide outcomes comparable to DES in bifurcation PCI. Their use may be reasonable in selected anatomies, but larger trials are needed to define their clinical advantage.