Strategies for Coronary Bifurcation Stenting: A Network Meta-analysis of Randomized Trials
Tuesday, May 21, 2019
Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)
Augustine Uzoma Njoku, M.D.
,
LSUHSC-S, Shreveport, LA
Khagendra Dahal, M.D.
,
LSU shreveport, Shreveport, LA
George Samir Nemr Mina, M.D.
,
LSU shreveport, Shreveport, LA
Pavan K. Katikaneni, M.D., FSCAI
,
Louisiana State University Health Science Center in Shreveport, Shreveport, LA
Kalgi Modi, M.D., FSCAI
,
LSUHSC, Shreveport, LA
Background:
Percutaneous coronary intervention (PCI) of coronary bifurcation lesions (CBL) results in worse clinical outcomes compared to non-bifurcation PCI. Although several strategies have been studied and used in intervening CBL, the superiority of one technique versus other remains unclear. We aimed to perform a network meta-analysis of randomized clinical trials (RCTs) that compared different PCI techniques in CBL.
Methods:
Electronic databases were searched for RCTs comparing different PCI strategies in patients with CBL. A network meta-analysis was performed using random-effects model to calculate the cumulative odds ratio (OR) with 95% credible interval (CI). Major adverse cardiovascular events (MACE), all-cause and cardiac mortality, target lesion revascularization (TLR), stent thrombosis (ST) and myocardial infarction (MI) were the major outcomes.
Results:
A total of 18 RCTs with 5263 total patients were available for analysis. The strategies used for intervention were DK-Crush (DKC), provisional stenting (PS), culotte, dedicated stenting (DS) and crush/tap/t-stenting (CTT). For TLR, DKC was superior to PS [odds ratio (OR): 0.38; 95% credible interval (CI): 0.20-0.74], DS [0.28 (0.11-0.73)] and culotte [0.37 (0.17-0.78)]. There was a trend towards reduction in TLR when DKC compared to CTT [0.49 (0.23-1.05). For ST, DKC was superior to culotte [0.17 (0.02-0.78)]. For other strategies there was no difference in the outcomes of TLR and ST. All five strategies resulted in similar risks of MACE, all-cause and cardiac mortality and MI.
Conclusions:
This network meta-analysis of RCTs shows that DK-Crush results in reduction in TLR compared to provisional stenting, dedicated stenting, and culotte, and reduction in ST compared to culotte. On the basis of our network meta-analysis of randomized clinical trials, we recommend using DK crush technique to achieve better cardiovascular outcomes whenever technically feasible in patients with coronary bifurcation lesions.
