Meng Shuai, Kong Xiangyun, Nan Jing, Yang Xingsheng, Li Jianan, Yang Shenghua, Zhao Lihan, Jin Zening
Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of General Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
Front Cardiovasc Med. 2023 Jul 24;10:1145412. doi: 10.3389/fcvm.2023.1145412. eCollection 2023.
The optimal percutaneous coronary intervention (PCI) strategy for coronary left main (LM) bifurcation lesions remains controversial. This meta-analysis compared the medium and long-term follow-up clinical outcomes of single vs. systematic dual stenting strategies of LM bifurcation lesions.
We systematically identified studies published within 5 years comparing single vs. systematic double stenting strategies for LM bifurcation lesions. The primary endpoint was medium-term (1 year) and long-term (at least 3 years) all-cause death. Secondary outcomes included major adverse cardiovascular events (MACEs), target lesion revascularization (TLR), overall occurrence of stent thrombosis (ST), cardiovascular (CV) mortality, and myocardial infarction (MI).
Two randomized controlled trials and nine observational studies with 7,318 patients were included in this meta-analysis. In terms of the medium-term follow-up clinical outcomes, our pooled analysis showed that use of the systematic dual stenting strategy was associated with a lower ST risk (odds ratio [OR] = 0.43, 95% confidence interval [CI]: 0.20-0.89, = 0.02) and cardiac death risk (OR = 0.43, 95% CI: 0.21-0.89, = 0.02) compared to the single stenting strategy; there was no significant difference between the two strategies regarding rates of all-cause death, MACE, TLR, and MI. Patients with long-term follow-up showed comparable observed clinical outcomes between the two strategies. Most importantly, for patients with true LM bifurcation, the risk of all-cause death, ST, and CV mortality following the systematic dual stenting strategy was significantly lower than the single stenting strategy.
For patients with LM bifurcation lesions, both the systematic dual stenting strategy and single stenting strategy demonstrated comparable results in terms of all-cause mortality during medium-term and long-term follow-up. However, the systematic dual stenting strategy showed a tendency towards lower incidence of ST and CV mortality compared to the single stenting strategy during medium-term follow-up. Consequently, the systematic dual stenting strategy yielded superior clinical outcomes for patients with LM bifurcation lesions.
冠状动脉左主干（LM）分叉病变的最佳经皮冠状动脉介入治疗（PCI）策略仍存在争议。本荟萃分析比较了LM分叉病变单支架与系统性双支架策略的中长期随访临床结果。
我们系统检索了5年内发表的比较LM分叉病变单支架与系统性双支架策略的研究。主要终点是中期（1年）和长期（至少3年）全因死亡。次要结局包括主要不良心血管事件（MACE）、靶病变血运重建（TLR）、支架血栓形成（ST）的总体发生率、心血管（CV）死亡率和心肌梗死（MI）。
本荟萃分析纳入了两项随机对照试验和九项观察性研究，共7318例患者。就中期随访临床结果而言，我们的汇总分析显示，与单支架策略相比，系统性双支架策略的ST风险较低（优势比[OR]=0.43，95%置信区间[CI]：0.20-0.89，P=0.02）和心源性死亡风险较低（OR=0.43，95%CI：0.21-0.89，P=0.02）；在全因死亡、MACE、TLR和MI发生率方面，两种策略之间无显著差异。长期随访患者显示两种策略的观察临床结果相当。最重要的是，对于真正的LM分叉病变患者，系统性双支架策略后的全因死亡、ST和CV死亡率风险显著低于单支架策略。
对于LM分叉病变患者，系统性双支架策略和单支架策略在中长期随访的全因死亡率方面显示出相当的结果。然而，在中期随访中，系统性双支架策略与单支架策略相比，ST和CV死亡率的发生率有降低的趋势。因此，系统性双支架策略为LM分叉病变患者带来了更好的临床结果。
