Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Advance Biomedical Sciences, Federico II University, Naples, Italy.
Division of Cardiology and Angiology II, University Heart Centre Freiburg, Bad Krozingen, Bad Krozingen, Germany.
JACC Cardiovasc Interv. 2020 Jun 22;13(12):1432-1444. doi: 10.1016/j.jcin.2020.03.054.
The aim of this study was to compare clinical outcomes of different bifurcation percutaneous coronary intervention (PCI) techniques.
Despite several randomized trials, the optimal PCI technique for bifurcation lesions remains a matter of debate. Provisional stenting has been recommended as the default technique for most bifurcation lesions. Emerging data support double-kissing crush (DK-crush) as a 2-stent technique.
PubMed and Scopus were searched for randomized controlled trials comparing PCI bifurcation techniques for coronary bifurcation lesions. Outcomes of interest were major adverse cardiovascular events (MACE). Secondary outcomes of interest were cardiac death, myocardial infarction, target vessel or lesion revascularization, and stent thrombosis. Summary odds ratios (ORs) were estimated using Bayesian network meta-analysis.
Twenty-one randomized controlled trials including 5,711 patients treated using 5 bifurcation PCI techniques were included. Investigated techniques were provisional stenting, T stenting/T and protrusion, crush, culotte, and DK-crush. Median follow-up duration was 12 months (interquartile range: 9 to 36 months). When all techniques were considered, patients treated using the DK-crush technique had less occurrence of MACE (OR: 0.39; 95% credible interval: 0.26 to 0.55) compared with those treated using provisional stenting, driven by a reduction in target lesion revascularization (OR: 0.36; 95% credible interval: 0.22 to 0.57). No differences were found in cardiac death, myocardial infarction, or stent thrombosis among analyzed PCI techniques. No differences in MACE were observed among provisional stenting, culotte, T stenting/T and protrusion, and crush. In non-left main bifurcations, DK-crush reduced MACE (OR: 0.42; 95% credible interval: 0.24 to 0.66).
In this network meta-analysis, DK-crush was associated with fewer MACE, driven by lower rates of repeat revascularization, whereas no significant differences among techniques were observed for cardiac death, myocardial infarction, and stent thrombosis. A clinical benefit of 2-stent techniques was observed over provisional stenting in bifurcation with side branch lesion length ≥10 mm.
本研究旨在比较不同分叉经皮冠状动脉介入治疗（PCI）技术的临床结果。
尽管进行了多项随机试验，但分叉病变的最佳 PCI 技术仍存在争议。临时支架置入术已被推荐作为大多数分叉病变的默认技术。新出现的数据支持双吻 crush（DK-crush）作为双支架技术。
在 PubMed 和 Scopus 上检索比较冠状动脉分叉病变 PCI 分叉技术的随机对照试验。主要心血管不良事件（MACE）是观察终点。次要观察终点包括心源性死亡、心肌梗死、靶血管或病变血运重建和支架血栓形成。使用贝叶斯网络荟萃分析估计汇总优势比（OR）。
共纳入 21 项随机对照试验，纳入 5711 例采用 5 种分叉 PCI 技术治疗的患者。研究技术包括临时支架置入术、T 支架/T 和突出术、crush 术、culotte 术和 DK-crush 术。中位随访时间为 12 个月（四分位间距：9 至 36 个月）。当所有技术均被考虑时，与临时支架置入术相比，DK-crush 技术治疗的患者 MACE 发生率较低（OR：0.39；95%可信区间：0.26 至 0.55），主要归因于靶病变血运重建减少（OR：0.36；95%可信区间：0.22 至 0.57）。分析的 PCI 技术之间在心源性死亡、心肌梗死或支架血栓形成方面无差异。临时支架置入术、culotte 术、T 支架/T 和突出术以及 crush 术之间的 MACE 无差异。在非左主干分叉病变中，DK-crush 降低 MACE（OR：0.42；95%可信区间：0.24 至 0.66）。
在这项网络荟萃分析中，DK-crush 与较少的 MACE 相关，主要归因于再血管化率较低，而在技术方面，心源性死亡、心肌梗死和支架血栓形成无显著差异。在侧支病变长度≥10mm 的分叉病变中，双支架技术较临时支架置入术有临床获益。
