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Double Versus Single Stenting for Coronary Bifurcation Lesions

A Meta-Analysis

From the Department of Cardiology (D.G.K.), Athens Euroclinic, Athens, Greece; the Clinical Trials and Evidence-Based Medicine Unit (G.C.M.S., J.P.A.I.), Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece; the Biomedical Research Institute (J.P.A.I.), Foundation for Research and Technology-Hellas, Ioannina, Greece; and the Institute for Clinical Research and Health Policy Studies (J.P.A.I.), Tufts Medical Center and Department of Medicine, Tufts University School of Medicine, Boston, Mass.

Correspondence to John P.A. Ioannidis, MD, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina 45110, Greece. E-mail jioannid{at}cc.uoi.gr

Received March 24, 2009; accepted July 22, 2009.

Background— Several trials have addressed whether bifurcation lesions require stenting of both the main vessel and side branch, but uncertainty remains on the benefits of such double versus single stenting of the main vessel only.

Methods and Results— We have conducted a meta-analysis of randomized trials including patients with coronary bifurcation lesions who were randomly selected to undergo percutaneous coronary intervention by either double or single stenting. Six studies (n=1642 patients) were eligible. There was increased risk of myocardial infarction with double stenting (risk ratio, 1.78; P=0.001 by fixed effects; risk ratio, 1.49 with Bayesian meta-analysis). The summary point estimate suggested also an increased risk of stent thrombosis with double stenting, but the difference was not nominally significant given the sparse data (risk ratio, 1.85; P=0.19). No obvious difference was seen for death (risk ratio, 0.81; P=0.66) and target lesion revascularization (risk ratio, 1.09; P=0.67).

Conclusions— Stenting of both the main vessel and side branch in bifurcation lesions may increase myocardial infarction and stent thrombosis risk compared with stenting of the main vessel only.

Key Words: angioplasty • coronary bifurcation • PCI • stents • meta-analysis

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