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

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.