Fujisaki Tomohiro, Kuno Toshiki, Numasawa Yohei, Takagi Hisato, Briasoulis Alexandros, Kwan Tak, Latib Azeem, Tamis-Holland Jacqueline, Bangalore Sripal
Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside and West, New York, New York.
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
J Soc Cardiovasc Angiogr Interv. 2022 Sep 30;1(5):100410. doi: 10.1016/j.jscai.2022.100410. eCollection 2022 Sep-Oct.
For bifurcating coronary lesions, a provisional stent technique is recommended compared with a routine 2-stent strategy. However, much of these data are from trials involving first-generation drug-eluting stents (DES) or bare-metal stents where the risk of restenosis with the 2-stent technique is higher. We investigated the efficacy of various 2-stent techniques versus a provisional stent technique for bifurcation lesions with newer-generation DES.
PubMed and Embase were searched through May 2022 for randomized control trials investigating bifurcation percutaneous coronary intervention techniques using newer-generation DES, and a meta-analysis was conducted. The primary end point was major adverse cardiovascular events (MACE) at the longest reported follow-up time.
Our study identified 13 randomized control trials including 4041 patients. Compared with the provisional technique, 2-stent techniques significantly decreased MACE (hazard ratio [HR], 0.76; 95% CI, 0.59-0.97; = .03), target vessel myocardial infarction (HR, 0.38; 95% CI, 0.20-0.71; = .002), and target vessel revascularization (HR, 0.66; 95% CI, 0.47-0.93; = .02). There were no significant differences in all-cause mortality (HR, 0.94; 95% CI, 0.62-1.45; = .79), cardiovascular mortality (HR, 0.82; 95% CI, 0.49-1.38; = .45), myocardial infarction (HR, 1.00; 95% CI, 0.73-1.37; = .99), and stent thrombosis (HR, 0.86; 95% CI, 0.52-1.44; = .58). Of the 2-stent techniques, the double kissing crush technique significantly decreased MACE and target lesion revascularization than other 2-stent techniques.
In this era of newer-generation DES, a 2-stent approach, especially the double kissing crush technique, is superior to a provisional stenting technique for a bifurcation lesion, with a significant reduction in MACE, target vessel myocardial infarction, and revascularization.
对于冠状动脉分叉病变，与常规双支架策略相比，推荐采用临时支架技术。然而，这些数据大多来自涉及第一代药物洗脱支架（DES）或裸金属支架的试验，其中双支架技术的再狭窄风险较高。我们研究了新一代DES治疗分叉病变时，各种双支架技术与临时支架技术的疗效。
检索截至2022年5月的PubMed和Embase数据库，以查找使用新一代DES研究分叉经皮冠状动脉介入技术的随机对照试验，并进行荟萃分析。主要终点是在报告的最长随访时间时的主要不良心血管事件（MACE）。
我们的研究确定了13项随机对照试验，包括4041例患者。与临时技术相比，双支架技术显著降低了MACE（风险比[HR]，0.76；95%置信区间，0.59 - 0.97；P = 0.03）、靶血管心肌梗死（HR，0.38；95%置信区间，0.20 - 0.71；P = 0.002）和靶血管血运重建（HR，0.66；95%置信区间，0.47 - 0.93；P = 0.02）。全因死亡率（HR，0.94；95%置信区间，0.62 - 1.45；P = 0.79）、心血管死亡率（HR，0.82；95%置信区间，0.49 - 1.38；P = 0.45）、心肌梗死（HR，1.00；95%置信区间，0.73 - 1.37；P = 0.99）和支架血栓形成（HR，0.86；95%置信区间，0.52 - 1.44；P = 0.58）方面无显著差异。在双支架技术中，双吻挤压技术比其他双支架技术显著降低了MACE和靶病变血运重建。
在新一代DES时代，对于分叉病变，双支架方法，尤其是双吻挤压技术，优于临时支架技术，可显著降低MACE、靶血管心肌梗死和血运重建。
