Percutaneous coronary intervention techniques for bifurcation disease: A network meta-analysis reveals superiority of double kissing crush

Abstract Background Provisional stenting (PS) is generally recommended to treat patients with coronary bifurcation disease (CBD) percutaneously, however PS may not fit all complex bifurcation anatomies. Therefore, several types of upfront two-stents techniques have been described. Here, we aimed to identify the best percutaneous coronary interventions (PCI) technique to manage patients with CBD. Methods We systematically reviewed RCTs including patients undergoing CBD PCI which included several types of PCI techniques: PS, double kissing (DK)-crush, TAP, culotte, dedicated bifurcation stents, crushing, T-stenting and we compared device oriented clinical events (DOCE), a composite of cardiac death, target-vessel myocardial infarction, stent thrombosis, target lesion revascularization OR target vessel revascularisation, in a network meta-analysis. We included 26 RCTs leading to a pooled population of 10339 patient-years and a total of 1229 DOCE. Results: The DK-crush technique was associated with the lowest DOCE rate, with risk ratio of 0.62, [0.42-0.92] as compared to the PS technique. DK-crush had the highest probability (model likelihood=90.2%, surface under the cumulative ranking curve=98.0%) of being the best technique among those explored, to reduce DOCE in patients receiving CBD PCI. Conclusions When a two-stent strategy is considered in a patient with CBD, the DK-Crush technique reduces DOCE compared to other bifurcation techniques based on all available RCTs.