Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA; Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of General Surgery, Mayo Clinic, Rochester, MN, USA; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.
Indian Heart J. 2024 Mar-Apr;76(2):113-117. doi: 10.1016/j.ihj.2024.03.004. Epub 2024 Mar 25.
Despite the development of dedicated, two-stent strategies, including the double kissing (DK) crush technique, the ideal technique for coronary artery bifurcation stenting has not been identified. We aimed to compare and determine the absolute risk difference (ARD) of the DK crush technique alone versus provisional stenting approaches for coronary bifurcation lesions, using the Bayesian technique.
We queried PubMed/MEDLINE to identify randomized controlled trials (RCTs) that compared DK crush technique with provisional stenting for bifurcation lesions, published till January 2023. We used Bayesian methods to calculate the ARD and 95% credible interval (CrI).
We included three RCTs, with 916 patients, in the final analysis. The ARD of cardiac death was centered at -0.01 (95% CrI: -0.04 to 0.02; Tau: 0.02, 85% probability of ARD of DK crush vs. provisional stenting <0). ARD for myocardial infarction was centered at -0.03 (95%CrI: -0.9 to 0.03; Tau: 0.05, 87% probability of ARD of DK crush vs. provisional stenting <0). ARD for stent thrombosis was centered at 0.00 (95% CrI: -0.04 to 0.03, Tau: 0.03, 51% probability of ARD for DK crush vs. provisional stenting <0). Finally, ARD for target lesion revascularization was centered at -0.05 (95% CrI: -0.08 to -0.03, Tau: 0.02, 99.97% probability of ARD for DK crush vs. provisional stenting <0).
Bayesian analysis demonstrated a lower probability of cardiac death, myocardial infarction and target lesion revascularization, with DK crush compared with provisional stenting techniques, and a minimal probability of difference in stent thrombosis.
尽管已经开发出了专用的双支架策略，包括双吻（DK）挤压技术，但冠状动脉分叉病变的理想支架技术仍未确定。我们旨在使用贝叶斯技术比较和确定 DK 挤压技术与分叉病变的临时支架置入术相比的绝对风险差异（ARD）。
我们在 PubMed/MEDLINE 上检索了比较 DK 挤压技术与分叉病变的临时支架置入术的随机对照试验（RCT），检索截止日期为 2023 年 1 月。我们使用贝叶斯方法计算 ARD 和 95%可信区间（CrI）。
我们最终纳入了三项 RCT，共 916 例患者。心脏死亡的 ARD 以 -0.01 为中心（95%CrI：-0.04 至 0.02；Tau：0.02，85%概率 DK 挤压 vs. 临时支架置入术的 ARD<0）。心肌梗死的 ARD 以 -0.03 为中心（95%CrI：-0.9 至 0.03；Tau：0.05，87%概率 DK 挤压 vs. 临时支架置入术的 ARD<0）。支架血栓形成的 ARD 以 0.00 为中心（95%CrI：-0.04 至 0.03，Tau：0.03，51%概率 DK 挤压 vs. 临时支架置入术的 ARD<0）。最后，靶病变血运重建的 ARD 以 -0.05 为中心（95%CrI：-0.08 至 -0.03，Tau：0.02，99.97%概率 DK 挤压 vs. 临时支架置入术的 ARD<0）。
贝叶斯分析显示，与临时支架置入术相比，DK 挤压技术的心脏死亡、心肌梗死和靶病变血运重建的概率更低，支架血栓形成的差异概率最小。
