■对于分叉的冠状动脉病变,与常规2支架策略相比,建议采用临时支架技术.然而,这些数据大部分来自涉及第一代药物洗脱支架(DES)或裸金属支架的试验,其中2-支架技术的再狭窄风险较高.我们研究了各种2支架技术与临时支架技术对新一代DES分叉病变的疗效。
■PubMed和Embase在2022年5月进行了随机对照试验,研究了使用新一代DES的分叉经皮冠状动脉介入治疗技术,并进行了荟萃分析。主要终点是报告的最长随访时间的主要不良心血管事件(MACE)。
■我们的研究确定了13项随机对照试验,包括4041名患者。与临时技术相比,2支架技术显著降低了MACE(危险比[HR],0.76;95%CI,0.59-0.97;P=0.03),目标血管心肌梗死(HR,0.38;95%CI,0.20-0.71;P=0.002),和目标血管血运重建(HR,0.66;95%CI,0.47-0.93;P=.02)。全因死亡率无显著差异(HR,0.94;95%CI,0.62-1.45;P=0.79),心血管死亡率(HR,0.82;95%CI,0.49-1.38;P=.45),心肌梗死(HR,1.00;95%CI,0.73-1.37;P=.99),和支架血栓形成(HR,0.86;95%CI,0.52-1.44;P=.58)。在双支架技术中,与其他2支架技术相比,双吻挤压技术显著降低了MACE和靶病变血运重建.
■在这个新一代DES时代,双支架入路,尤其是双吻技术,优于分叉病变的临时支架技术,随着MACE的显著减少,靶血管心肌梗死,和血运重建。
UNASSIGNED: For bifurcating coronary lesions, a provisional stent technique is recommended compared with a routine 2-stent strategy. However, much of these data are from trials involving first-generation drug-eluting stents (DES) or bare-metal stents where the risk of restenosis with the 2-stent technique is higher. We investigated the efficacy of various 2-stent techniques versus a provisional stent technique for
bifurcation lesions with newer-generation DES.
UNASSIGNED: PubMed and Embase were searched through May 2022 for randomized control trials investigating
bifurcation percutaneous coronary intervention techniques using newer-generation DES, and a meta-analysis was conducted. The primary end point was major adverse cardiovascular events (MACE) at the longest reported follow-up time.
UNASSIGNED: Our study identified 13 randomized control trials including 4041 patients. Compared with the provisional technique, 2-stent techniques significantly decreased MACE (hazard ratio [HR], 0.76; 95% CI, 0.59-0.97; P = .03), target vessel myocardial infarction (HR, 0.38; 95% CI, 0.20-0.71; P = .002), and target vessel revascularization (HR, 0.66; 95% CI, 0.47-0.93; P = .02). There were no significant differences in all-cause mortality (HR, 0.94; 95% CI, 0.62-1.45; P = .79), cardiovascular mortality (HR, 0.82; 95% CI, 0.49-1.38; P = .45), myocardial infarction (HR, 1.00; 95% CI, 0.73-1.37; P = .99), and stent thrombosis (HR, 0.86; 95% CI, 0.52-1.44; P = .58). Of the 2-stent techniques, the double kissing crush technique significantly decreased MACE and target lesion revascularization than other 2-stent techniques.
UNASSIGNED: In this era of newer-generation DES, a 2-stent approach, especially the double kissing crush technique, is superior to a provisional stenting technique for a
bifurcation lesion, with a significant reduction in MACE, target vessel myocardial infarction, and revascularization.