BACKGROUND Controversy still exists regarding the optimal treatment of coronary bifurcation lesions. AIMS We aimed to analyse the evidence from randomised controlled trials (RCTs) to compare outcomes following different bifurcation stenting techniques. METHODS We systematically searched for RCTs comparing different techniques published up to July 2022. We then conducted a pairwise meta-analysis to compare outcomes between provisional stenting (PS) versus upfront 2-stent techniques. Moreover, we performed a network meta-analysis (NMA) to compare all strategies with each other. The primary endpoint was major adverse cardiac events (MACE). RESULTS Twenty-four RCTs (6,890 patients) analysed PS, T-stenting, double-kissing (DK)-crush, crush, or culotte stenting. The pairwise meta-analysis did not reveal a significant difference between the PS and 2-stent techniques. However, the prespecified sensitivity analysis, which included RCTs exclusively enrolling patients with true bifurcation lesions, showed a lower rate of MACE following 2-stent techniques, and meta-regression indicated that a longer side branch lesion was associated with a greater benefit from the 2-stent strategy, which was the most apparent in RCTs with a mean lesion length >11 mm. NMA revealed that DK-crush was associated with the lowest MACE rate (odds ratio 0.47, 95% confidence interval: 0.36-0.62; p<0.01; PS as a reference). CONCLUSIONS Overall, 2-stent techniques were not significantly better than PS in terms of clinical outcomes. However, the results of the sensitivity analysis suggested that there might be a benefit of a 2-stent approach in selected patients with true bifurcation lesions, especially in the case of long side branch lesions. An NMA revealed that DK-crush was associated with the lowest event rates when compared with other techniques.

中文翻译：

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冠状动脉分叉病变不同支架置入技术的临床结果：随机对照试验的系统评价和网络荟萃分析。

背景关于冠状动脉分叉病变的最佳治疗仍然存在争议。目的 我们的目的是分析随机对照试验 (RCT) 的证据，以比较不同分叉支架置入技术的结果。方法 我们系统地检索了比较截至 2022 年 7 月发表的不同技术的随机对照试验。然后，我们进行了配对荟萃分析，以比较临时支架置入 (PS) 与预先 2 支架技术之间的结果。此外，我们进行了网络荟萃分析（NMA）来比较所有策略。主要终点是主要不良心脏事件（MACE）。结果 24 项随机对照试验（6,890 名患者）分析了 PS、T 型支架、双吻 (DK) 挤压、挤压或裙裤支架置入术。成对荟萃分析并未揭示 PS 和 2 支架技术之间的显着差异。然而，预先指定的敏感性分析（包括专门招募具有真正分叉病变的患者的随机对照试验）显示，2 支架技术后 MACE 发生率较低，并且荟萃回归表明，较长的侧分支病变与 2 支架技术的更大获益相关。 -支架策略，在平均病变长度>11毫米的随机对照试验中最为明显。NMA 显示，DK-crush 与最低的 MACE 率相关（比值比 0.47，95% 置信区间：0.36-0.62；p<0.01；PS 作为参考）。结论 总体而言，2 支架技术在临床结果方面并不明显优于 PS。然而，敏感性分析的结果表明，对于选定的具有真正分叉病变的患者，特别是在长侧分支病变的情况下，2 支架入路可能有好处。NMA 透露，与其他技术相比，DK-crush 的事件发生率最低。