Single versus double stenting for unprotected left main coronary artery bifurcation lesions: A systematic review and meta-analysis

Wassef Karrowni, Nader Makki, Amandeep S. Dhaliwal, Ankur Vyas, Amy Blevins, Saadeddine Dughman, Saket Girotra, Peter Cram, Phillip A. Horwitz

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: We conducted a meta-analysis to assess outcomes for a single-stent (SS) strategy versus a double-stent (DS) strategy in treatment of distal unprotected left main coronary artery (ULMCA) lesions in the drug-eluting stent (DES) era. BACKGROUND: Routine use of DES implantation has contributed to improved outcomes in patients undergoing percutaneous coronary intervention (PCI) for disease involving the ULMCA. However, PCI for ULMCA bifurcation lesions continues to be technically demanding and is an independent predictor of poor outcomes. While a number of stenting techniques have been described, the optimal strategy remains unknown. METHODS: SS treatment was defined as stenting of the main branch alone and DS treatment as stenting of both the main and side branches. Our co-primary endpoints were major adverse cardiovascular events (MACE), and its individual components. RESULTS: We identified 7 observational studies involving 2328 patients. Mean duration of follow-up was 32 months. We adopted the random effect model when computing the combined odds ratio (OR). There was decreased risk of MACE with SS strategy (20.4%) versus DS strategy (32.8%) (OR, 0.51; 95% confidence interval [CI], 0.35-0.73). There was also decreased target vessel/target lesion revascularization (TLR/TVR) with SS strategy (10.1%) versus DS strategy (24.3%) (OR, 0.35; 95% CI, 0.25-0.49). CONCLUSION: Compared to the DS strategy of percutaneous ULMCA bifurcation intervention, an SS approach may be associated with better outcomes.

Original languageEnglish (US)
Pages (from-to)229-233
Number of pages5
JournalJournal of Invasive Cardiology
Volume26
Issue number6
StatePublished - Jun 2014
Externally publishedYes

Keywords

  • drug-eluting stent
  • left main coronary artery
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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