Modified Double-stent Strategy May Be An Optimal Choice For Coronary Bifurcation Lesions:A Systematic Review And Meta-analysis

Background and objective: The modified double-stent and provisional stenting strategies have been widely used in patients with coronary bifurcation lesions,but what is the optimization has not been clearly defined.This meta-analysis was to elucidate the benefits from modified double-stent and provisional stenting strategies in patients with coronary bifurcation lesions.Methods: Pubmed,Embase,Web of Science,the Cochrane library as well as Chinese databases including CNKI,CBM,Wanfang and VIP were searched from establishment to December-30-2018.All the preliminary literatures were screened according to the predefined inclusion and exclusion criteria,quality assessment was also performed.The outcomes of this study consisted of clinical and angiographic ones.The clinical outcomes were divided into early(≤ 6 months)and late(> 6months)events according to the follow-up duration.The early endpoints included cardiac death,myocardial infarction,target lesion revascularization or target vessel revascularization and major adverse cardiac events(MACE),and the late endpoints also include stent thrombosis in addition to the early endpoints index.The angiographic endpoint was in-stent restenosis.Data were analyzed by the statistical software RevMan(version 5.3),fixed effects model were calculated for clinical and angiographic outcomes.Results: A total of 6 studies involving 1683 patients with coronary bifurcation lesions were included in this meta-analysis,which found that the modified double-stent strategy in patients with coronary bifurcation lesions was associated with a lower risk of cardiac death(OR=0.29,95%CI 0.11-0.78,P=0.01),myocardial infarction(OR=0.41,95%CI 0.21-0.82,P=0.01),target lesion revascularization or target vessel revascularization(OR=0.31,95%CI 0.15-0.63,P =0.001),and major adverse cardiac events(OR=0.41,95%CI 0.22-0.74,P=0.003)compared with provisional stenting in the early follow-up endpoint events,while the risk of cardiac death and stent thrombosis were similar between both strategies(OR=0.59,95% CI 0.31-1.10,P=0.09;and OR=0.62,95% CI0.34-1.15,P=0.13;respectively)in the late follow-up endpoint events.There were significant differences between both strategies in myocardial infarction(OR=0.42,95%CI 0.24-0.75,P=0.003),major adverse cardiac events(OR=0.44,95%CI 0.31-0.62,P<0.00001)and target lesion revascularization or target vessel revascularization(OR 0.35,95% CI 0.25-0.49,P<0.00001)between both strategies in the late follow-up endpoint events.The risk of in-stent restenosis favored the modified double-stent strategy(OR 0.29,95% CI 0.20-0.43,P<0.00001).Conclusion: The modified double-stent strategy was associated with excellent clinical and angiographic outcomes except for the occurrence of cardiac death and stent thrombosis late-term outcome compared with provisional stenting strategy in patients with coronary bifurcation lesions.These findings suggest that the modified double-stent strategy can be recommended as an optimization in patients with coronary bifurcation lesions.