Coronary bifurcation lesions: to stent one branch or both? A meta-analysis of patients treated with drug eluting stents.
BACKGROUND
In the treatment of coronary bifurcation lesions (CBL), with drug eluting stents (DES), we sought to compare angiographic and clinical outcomes of a simple strategy of stenting main vessel only with balloon dilatation of the side branch with a complex strategy of stenting both branches.


METHODS
We performed a meta-analysis of six studies, randomized (three) or prospective observational (three), including 963 patients, that directly compared the simple strategy to the complex strategy, in the treatment of CBL with DES.


RESULTS
Final minimal lumen diameter (MLD) of the side branch was significantly smaller in the simple strategy group [WMD -0.50 mm, 95% CI (-0.76, -0.24), p<0.00001]. The risk of main vessel restenosis [RR 0.66, 95% CI (0.38-1.17), p=0.16], side branch restenosis [RR 0.62, 95% CI (0.24-1.56), p=0.31], follow up death [RR 0.60, 95% CI (0.19-1.86), p=0.38], follow up myocardial infarction [RR 0.71, 95% CI (0.46-1.10), p=0.13], or target vessel revascularization [RR 0.90, 95% CI (0.56-1.46), p=0.67] was similar between the two strategies. The simple strategy showed a trend to a lower risk of early myocardial infarction [RR 0.65, 95% CI (0.41-1.05), p=0.08].


CONCLUSIONS
In the treatment of unselected CBL with DES, the complex strategy does not penalize angiographic and clinical outcomes compared to the simple strategy. Further randomized studies are needed to assess the benefit of simple or complex strategy in the treatment of specific subsets of bifurcated lesions.
Niccoli
Giampaolo
G
Institute of Cardiology, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168 Rome, Italy. gniccoli73@hotmail.it
Ferrante
Giuseppe
G
Porto
Italo
I
Burzotta
Francesco
F
Leone
Antonio M
AM
Mongiardo
Rocco
R
Mazzari
Mario A
MA
Trani
Carlo
C
Rebuzzi
Antonio G
AG
Crea
Filippo
F
D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D003324:Coronary Artery Disease / Q000628:therapy*; D003331:Coronary Vessels; D054855:Drug-Eluting Stents; D006801:Humans