Hakeem Abdul, Khan Faisal M, Bhatti Sabha, Samad Zainab, Effat Mohamed A, Eckman Mark H, Helmy Tarek
Division of Cardiovascular Diseases, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
J Invasive Cardiol. 2009 Nov;21(11):589-95.
To assess the optimal percutaneous coronary intervention (PCI) approach for coronary artery bifurcation lesions (CBL), we conducted a meta-analysis of randomized trials comparing provisional stenting (PS) to complex stenting strategy (CS).
PubMed, Cochrane Register of Controlled Trials, conference proceedings, and internet-based resources of clinical trials.
Six randomized trials comparing the PS to the CS approach for CBL with a total of 1,641 patients met the selection criteria for meta-analysis. There was no difference in the clinical profile between the two groups. No significant heterogeneity was found across trials. There was no difference in the reference vessel diameter of the main vessel (MV) (2.73 +/- 0.41 CS; 2.7 +/- 0.44 PS; p = 0.77) and side branch (SB) (2.31 +/- 0.33 CS; 2.27 +/- 0.34 PS; p = 0.30).There was no difference in the primary clinical outcome of major adverse cardiovascular events (MACE) between the two approaches (12.6% vs. 9.6%; relative risk [RR] 1.23, 95% CI, 0.91-1.68; p = 0.18). Similarly, no differences in other clinical endpoints including death (1% vs. 1.1%, RR 0.93, 95% CI, 0.37-;2.33; p = 0.87), target lesion revascularization (TLR) (6% vs. 5.3%, RR 1.10, 95% CI, 0.73-1.64; p = 0.66), stent thrombosis (ST) (1.8% vs. 0.8%, RR 1.60, 95% CI, 0.65-3.91; p = 0.30), MV restenosis (4.9% vs. 5%; RR 0.74, 95% CI, 0.40-1.38; p = 0.34) and SB restenosis (13.8% vs. 13.8%; RR 1.00, 95% CI, 0.65-1.54); p = 0.99] were observed at a mean follow up of 10 months and a mean angiographic follow up of 7 months. Myocardial infarction (MI) was, however, significantly higher in the CS vs. the PS group (6.8% vs. 3.6%, RR 1.71, 95% CI, 1.02-2.88; p = 0.04).
A CS strategy for CBL had a significantly higher risk of MI compared to a PS strategy. Rates of death, ST, restenosis and TLR were similar.
为评估冠状动脉分叉病变（CBL）的最佳经皮冠状动脉介入治疗（PCI）方法，我们对比较临时支架置入术（PS）与复杂支架置入策略（CS）的随机试验进行了荟萃分析。
PubMed、Cochrane对照试验注册库、会议论文集以及基于互联网的临床试验资源。
六项比较PS与CS治疗CBL方法的随机试验，共纳入1641例患者，符合荟萃分析的入选标准。两组患者的临床特征无差异。各试验间未发现显著异质性。主支血管（MV）（2.73±0.41 CS；2.7±0.44 PS；p = 0.77）和分支血管（SB）（2.31±0.33 CS；2.27±0.34 PS；p = 0.30）的参考血管直径无差异。两种方法的主要不良心血管事件（MACE）这一主要临床结局无差异（12.6%对9.6%；相对危险度[RR] 1.23，95%可信区间[CI]，0.91 - 1.68；p = 0.18）。同样，在平均10个月的随访和平均7个月的血管造影随访中，包括死亡（1%对1.1%，RR 0.93，95% CI，0.37 - 2.33；p = 0.87）、靶病变血运重建（TLR）（6%对5.3%，RR 1.10，95% CI，0.73 - 1.64；p = 0.66）、支架血栓形成（ST）（1.8%对0.8%，RR 1.60，95% CI，0.65 - 3.91；p = 0.30）、MV再狭窄（4.9%对5%；RR 0.74，95% CI，0.40 - 1.38；p = 0.34）和SB再狭窄（13.8%对13.8%；RR 1.00，95% CI，0.65 - 1.54；p = 0.99）等其他临床终点均未观察到差异。然而，CS组的心肌梗死（MI）显著高于PS组（6.8%对3.6%，RR 1.71，95% CI，1.02 - 2.88；p = 0.04）。
与PS策略相比，CBL的CS策略发生MI的风险显著更高。死亡、ST、再狭窄和TLR的发生率相似。
