44 Dedicated Bifurcation Stents Versus Drug Eluting Stents in Coronary Bifurcation Lesions: a Systemic Review and Meta-Analysis

IntroductionCoronary bifurcation lesions (CBL) constitute a fifth of all coronary lesions and have no optimal method for treatment.(1) Multiple trials were conducted to investigate different modalities of treatment such as drug eluting stents, bioresorbable scaffolds, and dedicated bifurcation stents.(2) There are limited data discussing the clinical outcomes of these trials as most tend to report procedural outcomes.(3) This systematic review aimed to compare clinical outcomes of DBS compared to DES, while excluding bare metal stents and bioresorbable scaffolds.(4)MethodsFollowing the PRISMA guidelines,(5) a systematic data search was conducted including EMBASE, PUBMED, MEDLINE, CINAHL, Cochrane database, TRIP database, and clinicaltrials.gov. Inclusion criteria were for prospective two-arm randomised trials published between the years from 2015 to 2018 comparing DBS and DES exclusively and reported clinical outcomes including cardiac death, myocardial infarction, target lesion revascularisation, and stent thrombosis. Risk of bias was assessed using Cochrane risk of bias assessment tool RoB1.(6) Two reviewers extracted data independently using Microsoft Excel 365 ProPlus. Meta-analysis is performed by restricted maximum-likelihood method comparing relative risks (RR) of clinical outcomes,(7) using MAJOR R pack through Jamovi platform and reported in logarithmic relative risk (Log RR).(8, 9)ResultsSix trials comparing DBS and DES involving 1914 patients met the inclusion criteria. Most of the studies were conducted in Europe, participants’ ages were DBS: 65.56, DES: 65.18 (p-value = 0.52). Participants of male gender were DBS: 74.9% DES: 77.5% (p-value = 0.44) and patients with smoking history were DBS: 28%, DES: 27.36% (p-value=0.70). Patients who presented with acute coronary syndrome were a fifth of all participants (p-value = 0.74). Around 70% of each arm participants had hypertension, and around 25% suffer from diabetes, as well as smoking. A third of participants had previous myocardial infarction (Table-1). Clinical outcomes were reported for 12 months in all study but one (Genereux et al. – 9 months).(10) There was only one cardiac death in the DBS arm compared to six cardiac deaths in the DES arm. A meta-analysis was performed for MACE (Figure-1), myocardial infarction (MI), stent thrombosis (ST), and target lesion revascularisation (TLR). Major adverse cardiac events (MACE) were 13.3% for DBS and 12.4% for DES with a RR of 1.078 (Log RR = 0.07, p-value = 0.612) (Figure-1 & Table-2). Other measured outcomes showed no superiority for either arms.ConclusionWhen comparing the one-year clinical outcomes for coronary bifurcation lesions stenting; there was no statistically significant difference between dedicated bifurcation stents and drug eluting stents regarding MACE, CD, MI, TLR, and ST.Conflict of InterestNone