- 作者：Marco Zimarino ; Aless ; ro Corazzini ; Fabrizio Ricci ; Marta Di Nicola ; Raffaele De Caterina
- 关键词：coronary bifurcation ; drug-eluting stent thrombosis ; percutaneous coronary intervention
- 刊名：JACC: Cardiovascular Interventions
- 出版年：2013
- 出版时间：July, 2013
- 年：2013
- 卷：6
- 期：7
- 页码：687-695
- 全文大小：1586 K
Objectives
This study sought to hypothesize that the higher risk of myocardial infarction (MI) documented after a routine double drug-eluting stent (DES) strategy (DDS) compared with a single DES strategy (SDS) with provisional stenting in percutaneous coronary interventions (PCI) of bifurcation lesions is driven by an increased rate of DES thrombosis.Background
The results of currently available randomized, controlled trials (RCTs) were inconclusive in the choice between SDS and DDS. Meta-analyses have shown an increased risk of MI in the DDS group, without identifying the underlying mechanism(s).
Methods
We performed a meta-analysis of 12 major (>100 patients) studies of bifurcation DES PCI: 5?RCTs and 7 nonrandomized observational studies, for a total of 6,961 patients. Random-effects models were used to calculate summary risk ratios (RRs). As a primary endpoint, we assessed the RRs and 95 % confidence intervals (CIs) of definite DES thrombosis; death, MI, and target vessel revascularization (TVR) were evaluated as secondary endpoints.
Results
Compared with SDS, DDS had an increased risk of DES thrombosis (RR: 2.31; 95 % CI: 1.33 to 4.03) and MI (RR: 1.86; 95 % CI: 1.34 to 2.60). Mortality (RR: 1.18; 95 % CI: 0.85 to 1.65) and TVR (RR: 1.02; 95 % CI: 0.80 to 1.30) were similar. The RRs of MI and DES thrombosis were associated (p?= 0.040).
Conclusions
In PCI of coronary bifurcations, SDS should be the preferred approach, as DDS is associated with an increased risk of MI, likely driven by DES thrombosis.