Is direct stenting superior to stenting with predilation in patients treated with percutaneous coronary intervention? Results from a meta-analysis of 24 randomised controlled trials.
BACKGROUND
In the last decade, direct stenting has been proposed as an alternative strategy to conventional stenting with balloon predilation. The aim of this study was to perform a meta-analysis of randomised trials comparing a direct stenting strategy versus a conventional one.


METHODS
A literature search was performed using Medline, EMBASE, the Cochrane Central Register of Controlled Trials, scientific session abstracts and relevant websites, from inception of each database to June 2009. Included studies comprised randomised controlled trials evaluating direct versus conventional stenting in patients undergoing percutaneous coronary intervention. Primary endpoint was the composite of death or myocardial infarction and secondary endpoints were myocardial infarction and target-vessel revascularisation occurrence.


RESULTS
24 trials met inclusion criteria, with 6803 patients enrolled (3412 or 50.15% randomised to direct stenting and 3391 or 49.85% randomised to conventional stenting). Up to 6-month follow-up, the composite of death or myocardial infarction was significantly reduced with direct stenting compared with conventional stenting (3.95% versus 5.10% respectively, OR=0.76 (95% CI 0.60 to 0.96), p=0.02). This reduction was primarily driven by a lower myocardial infarction occurrence (3.16% versus 4.04%, respectively, OR=0.77 (0.59 to 0.99), p=0.04). Furthermore, direct stenting was not associated with a reduction in target-vessel revascularisation (6.50% versus 6.96%, respectively, OR=0.92 (0.76 to 1.12), p=0.42).


CONCLUSIONS
This meta-analysis demonstrates that, in selected coronary lesions, direct stenting improves outcome in patients undergoing percutaneous coronary intervention, primarily reducing myocardial infarction incidence.
Piscione
Federico
F
Department of Clinical Medicine, Cardiovascular Sciences and Immunology, Via S Pansini 5, Naples, Italy. piscione@unina.it
Piccolo
Raffaele
R
Cassese
Salvatore
S
Galasso
Gennaro
G
D'Andrea
Claudia
C
De Rosa
Roberta
R
Chiariello
Massimo
M
D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D015982:Bias; D002404:Catheterization / Q000379:methods; D003131:Combined Modality Therapy / Q000379:methods; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D015607:Stents; D016896:Treatment Outcome