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Meta-Analysis
. 2018 Jun 27;13(6):e0197580.
doi: 10.1371/journal.pone.0197580. eCollection 2018.

Should kissing balloon inflation after main vessel stenting be routine in the one-stent approach? A systematic review and meta-analysis of randomized trials

Ming Zhong  1 , Biao Tang  1 , Qiang Zhao  1 , Jian Cheng  1 , Qiangsong Jin  1 , Shenwen Fu  1
Affiliations
Meta-Analysis

Should kissing balloon inflation after main vessel stenting be routine in the one-stent approach? A systematic review and meta-analysis of randomized trials

Ming Zhong et al. PLoS One. .

Abstract

The KBI (kissing balloon inflation) technique is considered the default strategy for the two-stent approach in real world practice. Studies comparing KBI and No-KBI in patients undergoing the one-stent approach have reported conflicting results. The meta-analysis was performed to compare the clinical outcomes of the KBI strategy and the No-KBI strategy for coronary bifurcation lesions in the one-stent approach. Five randomized studies were included, and a total of 1264 patients were involved in the meta-analysis. The primary outcome was cardiac death. The secondary end points were stent thrombosis, MI (myocardial infarction), target lesion revascularization (TLR), target vessel revascularization (TVR), and main vessel and side branch restenosis. Compared with the No-KBI strategy, the KBI strategy was associated with a significant reduction in side branch restenosis (OR: 0.44, 95% CI: 0.30-0.64, p<0.001). A high risk of main vessel restenosis was found in the KBI group (OR: 2.96, 95% CI: 1.74-5.01, p<0.001). There were no significant differences in rates of cardiac death (OR: 1.89, 95% CI: 0.60-5.95, p = 0.28), stent thrombosis (OR: 0.98, 95% CI: 0.19-4.94, p = 0.98), MI (OR: 0.68, 95% CI: 0.33-1.44, p = 0.30), TLR (OR 1.14, 95% CI 0.68-1.90, p = 0.62), or TVR (OR 1.27, 95% CI 0.75-2.16, p = 0.38). Compared with the No-KBI strategy, the KBI strategy reduced the incidence of side branch restenosis and increased the risk of main branch restenosis in the one-stent approach. However, the clinical outcomes were similar between the KBI and No-KBI groups.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study selection flow diagram.
Summary of progress through the stages of search and eligible study identification.
Fig 2
Fig 2. Forest plot of primary outcomes; cardiac death.
Fig 3
Fig 3
Forest plot of secondary end points; (A) stent thrombosis; (B) MI; (C) TLR; (D) TVR; (E) main vessel restenosis; (F) side branch restenosis. MI = myocardial infarction; TLR = target lesion revascularization; TVR = target vessel revascularization.
Fig 4
Fig 4
Influence analysis for cardiac death; (A) stent thrombosis (B); (C) MI; (D) TLR; (E) TVR; (F) main vessel restenosis; (G) side branch restenosis. MI = myocardial infarction; TLR = target lesion revascularization; TVR = target vessel revascularization.
Fig 5
Fig 5
Egger's test for cardiac death (A); MI (B); TLR (C); TVR (D); main vessel restenosis (E); side branch restenosis (F). MI = myocardial infarction; TLR = target lesion revascularization; TVR = target vessel revascularization.
Fig 6
Fig 6. Meta-regression analyses for side branch restenosis.
See this image and copyright information in PMC

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