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Meta-Analysis
. 2019 Apr 23;19(1):93.
doi: 10.1186/s12872-019-1070-y.

Cardiovascular outcomes associated with crush versus provisional stenting techniques for bifurcation lesions: a systematic review and meta-analysis

Affiliations
Meta-Analysis

Cardiovascular outcomes associated with crush versus provisional stenting techniques for bifurcation lesions: a systematic review and meta-analysis

Feng Huang et al. BMC Cardiovasc Disord. .

Abstract

Background: Percutaneous coronary intervention (PCI) for bifurcation lesions has often been challenging for Interventionists. Application of the correct intra-procedural technique is vital to generate beneficial outcomes after PCI. We aimed to systematically compare the post interventional cardiovascular outcomes which were reported using crush versus provisional stenting techniques for bifurcation lesions.

Methods: A computerized search was carried out through Medical Literature Analysis and Retrieval System Online, EMBASE, the Cochrane Central and through www.ClinicalTrials.gov for English publications comparing crush versus the provisional stenting techniques for coronary bifurcation lesions during PCI. Major adverse cardiac events, all-cause mortality, cardiac death, myocardial infarction, stent thrombosis, target vessel and target lesion revascularizations were the endpoints in this analysis. Odds ratios (OR) and 95% confidence intervals (CI) were generated during statistical analysis to represent the data.

Results: Six studies consisting of a total number of 2220 participants (1085 participants were assigned to the crush stenting technique and 1135 participants were assigned to the provisional stenting technique) enrolled between years 2004 and 2016 were included in this analysis. During a follow-up time period from six to sixty months, major adverse cardiac events (OR: 0.73, 95% CI: 0.59-0.91; P = 0.005), target vessel revascularization (OR: 0.62, 95% CI: 0.43-0.89; P = 0.01) and target lesion revascularization (OR: 0.62, 95% CI: 0.45-0.85; P = 0.003) were significantly lower in patients who were assigned to the crush stenting technique. However, all-cause mortality (OR: 0.90, 95% CI: 0.48-1.68; P = 0.74), cardiac death (OR: 0.56, 95% CI: 0.29-1.08; P = 0.08), myocardial infarction (OR: 0.89, 95% CI: 0.62-1.27; P = 0.53) and stent thrombosis (OR: 0.72, 95% CI: 0.36-1.42; P = 0.34) were not significantly different.

Conclusion: In patients with coronary bifurcation lesions undergoing PCI, crush stenting technique was associated with significantly lower major adverse cardiac events and repeated revascularization without any change in mortality, myocardial infarction and stent thrombosis when compared to the provisional technique showing a benefit of crush over the provisional stenting technique during PCI.

Keywords: Coronary bifurcation lesions; Crush stenting technique; Major adverse cardiac events; Percutaneous coronary intervention; Provisional stenting technique; Repeated revascularization.

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Conflict of interest statement

Authors’ information

Dr. Feng Huang is the first author. Institute of Cardiovascular Diseases and Guangxi Key Laboratory Base of Precision Medicine in Cardio-cerebrovascular Disease Control and Prevention and Guangxi Clinical Research Center for Cardio-cerebrovascular Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, China.

Ethics approval and consent to participate

Ethical approval was not applicable for this systematic review and meta-analysis.

Consent for publication

Not applicable.

Competing interests

Dr. Feng Huang and Dr. Zu-chun Luo declare that they have no potential conflicts of interest that might be relevant to the contents of this manuscript.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram representing the study selection for crush versus provisional stenting technique during percutaneous coronary intervention for coronary bifurcation lesions
Fig. 2
Fig. 2
Cardiovascular outcomes observed between crush versus provisional stenting techniques following percutaneous coronary intervention for bifurcation lesions [1 month – 60 months] (part 1)
Fig. 3
Fig. 3
Cardiovascular outcomes observed between crush versus provisional stenting techniques following percutaneous coronary intervention for bifurcation lesions [1 month to 60 months] (part 2)
Fig. 4
Fig. 4
Cardiovascular outcomes observed between crush versus provisional stenting techniques following percutaneous coronary intervention for bifurcation lesions at 12 months (part 1)
Fig. 5
Fig. 5
Cardiovascular outcomes observed between crush versus provisional stenting techniques following percutaneous coronary intervention for bifurcation lesions at 12 months (part 2)
Fig. 6
Fig. 6
Funnel plot showing publication bias (A)
Fig. 7
Fig. 7
Funnel plot showing publication bias (B)

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