Department of Cardiology, Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium.
J Invasive Cardiol. 2022 Apr;34(4):E334-E342. doi: 10.25270/jic/21.00093.
We aimed to assess which bifurcation technique performs best in unprotected left-main (LM) percutaneous coronary intervention (PCI).
Provisional stenting was considered the preferred technique for LM bifurcation PCI due to the supposed lower risks of thrombosis and restenosis. However, recent studies showed potential advantages of double kissing (DK)-crush technique over the other strategies.
We performed a frequentist network meta-analysis comparing different stenting techniques in the setting of LM bifurcation. PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov were searched. Both randomized clinical trials and non-randomized clinical trials were considered eligible for inclusion. Incidence rate ratios (IRRs) were computed using a random-effects model for death, cardiac death, myocardial infarction, target-vessel revascularization, target-lesion revascularization, and stent thrombosis, including 95% confidence intervals (CIs).
A total of 10 studies (2364 patients) were included. Compared with provisional stenting, DK-crush was associated with fewer cardiac deaths (IRR, 0.34; 95% CI, 0.17-0.70; P<.01), myocardial infarctions (IRR, 0.19; 95% CI, 0.08-0.44; P<.001), stent thromboses (IRR, 0.31; 95% CI, 0.14-0.69; P<.01), target-vessel revascularizations (IRR, 0.25; 95% CI, 0.14-0.46; P<.001), and target-lesion revascularizations (IRR, 0.25; 95% CI, 0.14-0.46; P<.001). DK-crush was also associated with a lower risk of myocardial infarction (IRR, 0.19; 95% CI, 0.05-0.76; P=.02) when compared with standard crush and lower risk of target-lesion revascularization when compared with culotte (IRR, 0.32; 95% CI, 0.12-0.83; P=.02) and crush (IRR, 0.07; 95% CI, 0.02-0.28; P<.001).
DK-crush is the best technique for unprotected LM bifurcation PCI.
我们旨在评估在无保护左主干（LM）经皮冠状动脉介入治疗（PCI）中哪种分叉技术效果最佳。
由于血栓形成和再狭窄的风险较低，临时支架置入被认为是 LM 分叉 PCI 的首选技术。然而，最近的研究显示，双吻（DK）- crush 技术相对于其他策略具有潜在优势。
我们进行了一项频率论者网络荟萃分析，比较了 LM 分叉处不同支架置入技术。检索了 PubMed、Embase、Cochrane 对照试验中心注册库和 Clinicaltrials.gov。纳入了随机临床试验和非随机临床试验。使用随机效应模型计算死亡率、心脏性死亡率、心肌梗死、靶血管血运重建、靶病变血运重建和支架血栓形成的发生率比值（IRR），并计算 95%置信区间（CI）。
共纳入 10 项研究（2364 例患者）。与临时支架置入相比，DK-crush 与较低的心脏性死亡率（IRR，0.34；95%CI，0.17-0.70；P<.01）、心肌梗死（IRR，0.19；95%CI，0.08-0.44；P<.001）、支架血栓形成（IRR，0.31；95%CI，0.14-0.69；P<.01）、靶血管血运重建（IRR，0.25；95%CI，0.14-0.46；P<.001）和靶病变血运重建（IRR，0.25；95%CI，0.14-0.46；P<.001）相关。与标准 crush 相比，DK-crush 还与较低的心肌梗死风险相关（IRR，0.19；95%CI，0.05-0.76；P=.02），与 culotte（IRR，0.32；95%CI，0.12-0.83；P=.02）和 crush（IRR，0.07；95%CI，0.02-0.28；P<.001）相比，靶病变血运重建的风险较低。
DK-crush 是无保护 LM 分叉 PCI 的最佳技术。
