One- and 3-year outcomes of percutaneous bifurcation left main revascularization with modern drug-eluting stents: a syst
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REVIEW
One‑ and 3‑year outcomes of percutaneous bifurcation left main revascularization with modern drug‑eluting stents: a systematic review and meta‑analysis Gianluca Rigatelli1 · Marco Zuin1,2 · Pavel Nikolov3 · Nyha Mileva3 · Dobrin Vassilev3 Received: 13 April 2020 / Accepted: 26 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Aims Optimal percutaneous coronary intervention (PCI) strategy for coronary left main (LM) bifurcation lesions remains controversial. We performed systematic review and meta-analysis comparing one and 3-year clinical outcomes of 1- and 2- stent strategies using modern drug eluting stents (DESs) for revascularization of LM bifurcation disease. Methods We systematically identified all investigations published between January 2015 and February 2020 comparing the use of single versus double-stent strategies for the revascularization of LM bifurcation lesions. The primary endpoint was 1- and 3-years all-cause mortality. Secondary outcomes included target lesion revascularization (TLR), target lesion failure (TLF), major adverse cardiovascular vents (MACEs) and cardiovascular (CV) mortality while the tertiary outcome was overall occurrence of stent thrombosis (ST) at 1- and 3-years. Results No significant differences were observed between the two groups in terms of all-cause mortality rate both at 1 and 3-year follow-up. Single stent strategy was associated with a significantly lower risk of TLR (OR 0.78, 95% CI 0.62- 0.97, p = 0.03, I2 = 61%) as well as of MACEs (OR 0.78, 95% CI 0.63–0.97, I2 = 24%) compared to 2-stent strategy. Conversely no significant differences between the two groups were observed in terms of TLF, CV mortality and ST during the same follow-up period. Conclusions In patients with LM bifurcation disease, single stent strategy demonstrated lower rate of MACEs and TLR but was not superior to 2-stent strategy in terms of CV mortality, TLF and ST at 1 and 3-year follow-up.
Gianluca Rigatelli and Marco Zuin equally contributed to the manuscript. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00392-020-01679-w) contains supplementary material, which is available to authorized users. * Gianluca Rigatelli [email protected] 1
Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Viale tre Martiri, 45100 Rovigo, Italy
2
University of Ferrara, School of Medicine, Ferrara, Italy
3
Department of Cardiology, Alexandrovska University Hospital, Sofia, Bulgaria
13
Vol.:(0123456789)
Clinical Research in Cardiology
Graphic abstract
Keywords Left main bifurcation · Technique · Outcomes
Introduction The optimal percutaneous coronary interventions (PCI) strategy for coronary bifurcation lesions treatment remains a matter of speculation in current clinical practice [1]. Several recent investigations and meta-analyses on the topic have generally compared the use of a single- versus double-stent strategy in large cohorts enrolling patients with gener
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