title: Single versus double stenting for unprotected left main coronary artery bifurcation lesions: a systematic review and meta-analysis.
abstract: OBJECTIVE
  We conducted a meta-analysis to assess outcomes for a single-stent (SS) strategy versus a double-stent (DS) strategy in treatment of distal unprotected left main coronary artery (ULMCA) lesions in the drug-eluting stent (DES) era.
  
  
  BACKGROUND
  Routine use of DES implantation has contributed to improved outcomes in patients undergoing percutaneous coronary intervention (PCI) for disease involving the ULMCA. However, PCI for ULMCA bifurcation lesions continues to be technically demanding and is an independent predictor of poor outcomes. While a number of stenting techniques have been described, the optimal strategy remains unknown.
  
  
  METHODS
  SS treatment was defined as stenting of the main branch alone and DS treatment as stenting of both the main and side branches. Our co-primary endpoints were major adverse cardiovascular events (MACE), and its individual components.
  
  
  RESULTS
  We identified 7 observational studies involving 2328 patients. Mean duration of follow-up was 32 months. We adopted the random effect model when computing the combined odds ratio (OR). There was decreased risk of MACE with SS strategy (20.4%) versus DS strategy (32.8%) (OR, 0.51; 95% confidence interval [CI], 0.35-0.73). There was also decreased target vessel/target lesion revascularization (TLR/TVR) with SS strategy (10.1%) versus DS strategy (24.3%) (OR, 0.35; 95% CI, 0.25-0.49).
  
  
  CONCLUSIONS
  Compared to the DS strategy of percutaneous ULMCA bifurcation intervention, an SS approach may be associated with better outcomes.
authors.affiliation: University of Iowa Carver College of Medicine, Iowa City, Iowa USA. amandeep-dhaliwal@uiowa.edu.
authors.forename: Wassef
authors.initials: W
authors.lastname: Karrowni
authors.forename: Nader
authors.initials: N
authors.lastname: Makki
authors.forename: Amandeep S
authors.initials: AS
authors.lastname: Dhaliwal
authors.forename: Ankur
authors.initials: A
authors.lastname: Vyas
authors.forename: Amy
authors.initials: A
authors.lastname: Blevins
authors.forename: Saadeddine
authors.initials: S
authors.lastname: Dughman
authors.forename: Saket
authors.initials: S
authors.lastname: Girotra
authors.forename: Peter
authors.initials: P
authors.lastname: Cram
authors.forename: Phillip A
authors.initials: PA
authors.lastname: Horwitz
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000628:therapy*; D054855:Drug-Eluting Stents; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome