Updated Meta-Analysis of Provisional vs Dedicated Two-Stent Coronary Bifurcation Stenting Techniques

Charlton, Blake

Updated Meta-Analysis of Provisional vs Dedicated Two-Stent Coronary Bifurcation Stenting Techniques

Tuesday, May 21, 2019

Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)

Harsh Agarwal, MD , UCSF, San Francisco, CA

Blake R Charlton, M.D. , UCSF, San Francisco, CA

Kendrick A. Shunk, M.D., Ph.D. , UCSF& San Francisco VA Medical Center, San Francisco, CA

Muditha Perera, PhD , Texas Tech University Health Science Center, El Paso, TX

Alok K Dwivedi, PhD , Texas Tech University Health Science Center, El Paso, TX

Vaikom R Mahadevan, MD , UCSF, San Francisco, CA

Background:
Prior meta-analysis as well as sub-group analysis of the EXCEL trial found that provisional compared to two-stent bifurcation stenting technique was associated with better outcomes. We have performed an updated meta-analysis to include all newly published randomized controlled trial data.

Methods:
We searched Medline, EMBase, and the Cochrane library until January 2018 for studies comparing provisional and two-stent strategies. Twelve randomized controlled trials, including 3,664 patients, were identified. Using Stata 15, random effects model risk ratios were calculated for the outcomes of interest.

Results:
The relative risk (95% confidence interval) for all-cause mortality, cardiovascular mortality, myocardial infarction, target lesion revascularization, stent thrombosis, and MACE for a provisional vs. two-stent strategy were 0.71 (0.45-1.11), 0.92 (0.53-1.62), 0.76 (0.53-1.10), 1.06 (0.74-1.53), 1.26 (0.61-2.61), and 1.27 (0.81-1.98) respectively.

Conclusions:
No difference in outcomes was found between provisional and two-stent bifurcation stenting strategies. Unlike previous analysis, no increase in mortality or myocardial infarct was observed with a two-stent strategy, suggesting that technique choice should be left to operator discretion.