P970DK-crush is the best treatment strategy to reduce stent oriented clinical outcome, results from a network meta-analysis of twenty-six randomized clinical trials comparing different stent techniques
| Autor: | Marco Ferlini, Alessandra Repetto, Gabriele Crimi, C Strozzi, L Oltrona Visconti, Annalisa De Silvestri, Claudio Montalto, Barbara Marinoni, Valeria Scotti, Catherine Klersy, A Mandurino Mirizzi, S. De Servi, Maurizio Ferrario, Fabrizio D'Ascenzo, Valeria Gritti |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
business.industry medicine.medical_treatment Stent Percutaneous coronary intervention medicine.disease Revascularization Outcome (game theory) Surgery law.invention surgical procedures operative Randomized controlled trial law Meta-analysis medicine Treatment strategy Myocardial infarction Cardiology and Cardiovascular Medicine business |
| Zdroj: | European Heart Journal. 40 |
| ISSN: | 1522-9645 0195-668X |
| DOI: | 10.1093/eurheartj/ehz747.0564 |
| Popis: | Background Coronary bifurcation disease (CBD) accounts for approximately 20% of all and is associated with worse short- and long- term clinical outcomes. Provisional stenting (PS) is the preferred choice, however, this approach may not be suitable in all CBD anatomies, therefore several elective two-stents techniques have been described, however there is lack of randomized evidence to guide interventionalist across different stent techniques. Objectives. To identify the best percutaneous coronary interventions (PCI) technique for CBD. Methods We systematically review randomized clinical (RCTs) of patients receiving CBD PCI with either PS or six type of elective two-stent techniques (DK-crush, TAP, culotte, dedicated bifurcation stents, crushing, T-stenting) and compare device oriented clinical events (DOCE) in a network meta-analysis. DOCE was defined as composite of cardiac death, target-vessel myocardial infarction, stent thrombosis, target lesion revascularization OR target vessel revascularisation. Results We included 26 RCTs leading to a pooled population of 10339 patients-years with 1229 DOCE. Compared to PS, the DK-crush technique had a lower DOCE with RR=0.62, [0.42–0.92]. Figure. DK-crush had the highest likelihood (model likelihood=90.2%, SUCRA=98.0%) of being the best treatment to reduce DOCE. Figure 1 Conclusions In the management CBD, when a two-stent technique is required as upfront strategy, the DK- Crush technique should be privileged as it showed to reduce stent-related clinical outcomes (DOCE) when compared to other bifurcation techniques. |
| Databáze: | OpenAIRE |
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