Key result
Provisional stenting cuts long-term all-cause mortality ~31% vs up-front 2-stent strategy in bifurcation lesions.
Why the study?
Long-term follow-up data comparing provisional single-stent versus up-front 2-stent strategies for coronary bifurcation lesions are evolving and require synthesis.
Does a provisional single-stent strategy reduce all-cause mortality compared to an up-front 2-stent strategy in patients with coronary bifurcation lesions?
Meta-Analysis (n=3,265)
Does a provisional single-stent strategy reduce all-cause mortality compared to an up-front 2-stent strategy in patients with coronary bifurcation lesions?
Relative Risk: 0.69 (95% CI 0.48–1)
Absolute Event Rate: 2.94% vs 4.23%
p-value: p=0.049
A provisional single-stent strategy for coronary bifurcation lesions is associated with lower long-term all-cause mortality compared to an up-front 2-stent strategy.
Provisional single-stent strategy linked to lower long-term all-cause mortality; reinforces short-term RCT evidence favoring it over routine 2-stent for bifurcation lesions.
Background The majority of coronary bifurcation lesions are treated with a provisional single‐stent strategy rather than an up‐front 2‐stent strategy. This approach is supported by multiple randomized controlled clinical trials with short‐ to medium‐term follow‐up; however, long‐term follow‐up data is evolving from many data sets. Methods and Results Meta‐analysis of randomized controlled trials evaluating long‐term outcomes (≥1 year) according to treatment strategy for coronary bifurcation lesions. Nine randomized controlled trials with 3265 patients reported long‐term clinical outcomes at mean weighted follow‐up of 3.1±1.8 years. Provisional single stenting was associated with lower all‐cause mortality (2.94% versus 4.23%; risk ratio: 0.69; 95% confidence interval, 0.48–1.00; P =0.049; I 2 =0). There was no difference in major adverse cardiac events (15.8% versus 15.4%; P =0.79), myocardial infarction (4.8% versus 5.5%; P =0.51), target lesion revascularization (9.3% versus 7.6%; P =0.19), or stent thrombosis (1.8% versus 1.6%; P =0.28) between the groups. Prespecified sensitivity analysis of long‐term mortality at a mean of 4.7 years of follow‐up showed that the provisional single‐stent strategy was associated with reduced all‐cause mortality (3.9% versus 6.2%; risk ratio: 0.63; 95% confidence interval, 0.42–0.97; P =0.036; I 2 =0). Conclusions Coronary bifurcation percutaneous coronary intervention using a provisional single‐stent strategy is associated with a reduction in all‐cause mortality at long‐term follow‐up.
No takes yet. Share an insight, caveat, or question.
Ford et al. (2018) conducted a meta-analysis in Coronary bifurcation lesions (n=3,265). Provisional single-stent strategy vs. Up-front 2-stent strategy was evaluated on All-cause mortality (RR 0.69, 95% CI 0.48-1.00, p=0.049). A provisional single-stent strategy for coronary bifurcation lesions reduced long-term all-cause mortality compared to an up-front 2-stent strategy (2.94% vs 4.23%; RR 0.69; 95% CI 0.48-1.00; P=0.049).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: