Author + information
- Received February 4, 2020
- Revision received March 25, 2020
- Accepted March 31, 2020
- Published online June 15, 2020.
- Giuseppe Di Gioia, MDa,b,
- Jeroen Sonck, MDa,b,
- Miroslaw Ferenc, MDc,
- Shao-Liang Chen, MD, PhDd,e,
- Iginio Colaiori, MDa,
- Emanuele Gallinoro, MDa,
- Takuya Mizukami, MD, PhDa,f,
- Monika Kodeboina, MDa,b,
- Sakura Nagumo, MD, PhDa,f,
- Danilo Franco, MDb,
- Jozef Bartunek, MD, PhDa,
- Marc Vanderheyden, MD, PhDa,
- Eric Wyffels, MDa,
- Bernard De Bruyne, MD, PhDa,
- Jens F. Lassen, MD, PhDg,
- Johan Bennett, MD, PhDh,
- Dobrin Vassilev, MD, PhDi,
- Patrick W. Serruys, MD, PhDj,
- Goran Stankovic, MD, PhDk,
- Yves Louvard, MD, PhDl,
- Emanuele Barbato, MD, PhDb and
- Carlos Collet, MD, PhDa,∗ (, )@ColletCarlos
- aCardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- bDepartment of Advance Biomedical Sciences, Federico II University, Naples, Italy
- cDivision of Cardiology and Angiology II, University Heart Centre Freiburg, Bad Krozingen, Bad Krozingen, Germany
- dDivision of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- eKey Laboratory of Cardiovascular and Cerebrovascular Medicine, School of Pharmacy, Nanjing Medical University, Nanjing, China
- fDivision of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan
- gDepartment of Cardiology, Odense University Hospital & University of Southern Denmark, Odense, Denmark
- hDepartment of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
- i“Alexandrovska” University Hospital, Sofia, Bulgaria
- jDepartment of Cardiology, National University of Ireland, Galway, Ireland
- kDepartment for Diagnostic and Catheterization Laboratories, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- lDepartment of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Hopital Privé Jacques Cartier, Massy, France
- ↵∗Address for correspondence:
Dr. Carlos Collet, Cardiovascular Center Aalst, OLV Clinic, Moorselbaan 164, Aalst, Belgium 9300.
Objectives The aim of this study was to compare clinical outcomes of different bifurcation percutaneous coronary intervention (PCI) techniques.
Background Despite several randomized trials, the optimal PCI technique for bifurcation lesions remains a matter of debate. Provisional stenting has been recommended as the default technique for most bifurcation lesions. Emerging data support double-kissing crush (DK-crush) as a 2-stent technique.
Methods PubMed and Scopus were searched for randomized controlled trials comparing PCI bifurcation techniques for coronary bifurcation lesions. Outcomes of interest were major adverse cardiovascular events (MACE). Secondary outcomes of interest were cardiac death, myocardial infarction, target vessel or lesion revascularization, and stent thrombosis. Summary odds ratios (ORs) were estimated using Bayesian network meta-analysis.
Results Twenty-one randomized controlled trials including 5,711 patients treated using 5 bifurcation PCI techniques were included. Investigated techniques were provisional stenting, T stenting/T and protrusion, crush, culotte, and DK-crush. Median follow-up duration was 12 months (interquartile range: 9 to 36 months). When all techniques were considered, patients treated using the DK-crush technique had less occurrence of MACE (OR: 0.39; 95% credible interval: 0.26 to 0.55) compared with those treated using provisional stenting, driven by a reduction in target lesion revascularization (OR: 0.36; 95% credible interval: 0.22 to 0.57). No differences were found in cardiac death, myocardial infarction, or stent thrombosis among analyzed PCI techniques. No differences in MACE were observed among provisional stenting, culotte, T stenting/T and protrusion, and crush. In non–left main bifurcations, DK-crush reduced MACE (OR: 0.42; 95% credible interval: 0.24 to 0.66).
Conclusions In this network meta-analysis, DK-crush was associated with fewer MACE, driven by lower rates of repeat revascularization, whereas no significant differences among techniques were observed for cardiac death, myocardial infarction, and stent thrombosis. A clinical benefit of 2-stent techniques was observed over provisional stenting in bifurcation with side branch lesion length ≥10 mm.
This work was supported by the VZW Cardiovascular Research Centre, Aalst, Belgium. Drs. Di Gioia, Sonck, and Kodeboina received research grants by the CardioPaTh PhD programme. Dr. Ferenc received speaker honoraria from Boston Scientific, Medtronic, Teleflex, Terumo, Abiomed, and Biotronik. Dr. Collet has received research grants from Biosensor, Heart Flow, and Abbott Vascular; and has received consultancy fees from Heart Flow and Philips Volcano. Dr. Mizukami has received consultancy fees from Heart Flow. Dr. De Bruyne has received consultancy fees on his behalf from Boston Scientific, St. Jude Medical, and Opsens. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received February 4, 2020.
- Revision received March 25, 2020.
- Accepted March 31, 2020.
- 2020 American College of Cardiology Foundation
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