Bifurcation stenting with drug-eluting stents: a systematic review and meta-analysis of randomised trials.
OBJECTIVE
We sought to determine if outcomes differ between provisional (elective side branch stenting) compared to a routine two-stent strategy (mandatory side branch stenting) for the treatment of bifurcation stenoses of the coronary arteries using drug-eluting stents.


RESULTS
We searched Medline, EMBASE, and the Cochrane library from January 2000 to February 2009 for studies comparing the provisional and two-stent strategies. Six randomised controlled trials, including 1,641 patients, were identified. The relative risk (95% confidence interval) for death, MI, target lesion revascularisation, and stent thrombosis within 1-year of the index procedure for a provisional vs. two-stent strategy were 1.12 (0.42-3.02), 0.57 (0.37-0.87), 0.91 (0.61-1.35), and 0.56 (0.23-1.35), respectively. By quantitative coronary angiography, there was no difference in the difference in means (95% CI) between the provisional and two-stent strategies for percent diameter stenosis (95% CI) in the main vessel or side branch, -1.08 (-2.91 to 0.74) and 1.30 (-3.35 to 5.96), respectively.


CONCLUSIONS
While death, stent thrombosis, and restenosis were similar between the treatment groups, MI was more common with the two-stent strategy. Thus, compared to a routine two-stent strategy, provisional stenting yields similar efficacy with superior safety and lower costs.
Brar
Somjot S
SS
Columbia University Medical Center, New York, NY, USA. SBrar@cvri.org
Gray
William A
WA
Dangas
George
G
Leon
Martin B
MB
Aharonian
Vicken J
VJ
Brar
Simerjeet K
SK
Moses
Jeffrey W
JW
D017023:Coronary Angiography / Q000379:methods / Q000706:statistics & numerical data; D003643:Death; D054855:Drug-Eluting Stents / Q000009:adverse effects; D004867:Equipment Design; D006801:Humans; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D017239:Paclitaxel / Q000008:administration & dosage / Q000627:therapeutic use; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012306:Risk; D020123:Sirolimus / Q000008:administration & dosage / Q000627:therapeutic use; D013927:Thrombosis / Q000453:epidemiology; D016896:Treatment Outcome
D017239:Paclitaxel; D020123:Sirolimus