Dedicated Bifurcation Stents for Coronary Bifurcation Lesions: A Systematic Review and Meta-Analysis of Randomized-Controlled Trials

Background. Percutaneous coronary intervention (PCI) of coronary bifurcation lesions (CBL) remains a challenge in contemporary practice due to the procedural and technical difficulties involved. We sought to review the current evidence on the safety and clinical outcomes of dedicated bifurcation stent (DBS) implantation in comparison with established treatment strategies for CBL-PCI. Methods. We conducted a comprehensive search to identify randomized control trials (RCTs) reporting 1-year clinical and angiographic outcomes of patients undergoing CBL-PCI with DBS vs conventional CBL-PCI strategies. Random-effects meta-analyses were performed to estimate the effect of DBS compared with conventional CBL-PCI using aggregate data. Results. A total of 5 RCTs comprising 1249 participants met the inclusion criteria. The use of DBS was comparable to conventional stenting techniques in terms of major adverse cardiovascular event (MACE) rate (odds ratio [OR], 1.28; 95% confidence interval [CI], 0.90-1.82; I-2=0%), all-cause mortality (OR, 0.80; 95% CI, 0.31-2.07; I-2=0%), cardiac mortality (OR, 0.16; 95% CI, 0.02-1.39; I-2=0%), myocardial infarction (OR, 1.26; 95% CI, 0.84-1.89; I-2=0%), definite stent thrombosis (OR, 1.75; 95% CI, 0.36-8.52; I-2=0%), cumulative target-lesion revascularization (OR, 1.39; 95% CI, 0.85-2.27; I-2=0%), clinically driven target-lesion revascularization (OR, 1.23; 95% CI, 0.68-2.22; I-2=0%), or target-vessel revascularization (OR, 1.43; 95% CI, 0.92-2.22; I-2=0%). Conclusion. The present analysis suggests that CBL-PCI with DBS may be associated with similar 1-year clinical and angiographic outcomes compared with conventional CBL-PCI strategies. However, the low quality of evidence and limited follow-up warrant further studies to ascertain any significant differences in patient-important outcomes before the adoption of DBS into routine CBL-PCI practice.