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Final kissing ballooning (FKB) can be an effective approach to improve procedural results in coronary bifurcation lesions treated with 1-stent technique. However, studies showed inconsistent results in benefit of FKB on long-term clinical outcomes.
We searched the literature in Medline, EMBASE, the Clinical Trials Registry (www.clinicaltrials.gov) and Cochrane Library Central Register of Controlled Trials (CENTRAL) from January 2000 to April 2017. Studies that compare clinical outcomes between FKB and no FKB in bifurcation lesion intervention with only MV drug-eluting stents(DES) implantation were selected for meta-analysis. Random-effects model were used to calculate summary risk ratios (RRs) for assessment of treatment effect. Subgroup analyses were performed in patients with left main coronary artery (LM) bifurcation interventions compared to non-LM bifurcation intervention, and patients with large SB bifurcation lesions (defined as SB diameter more than 2.5mm and SB of LM bifurcation) compared to non-large SB bifurcation lesions.
11 eligible studies, including 3 randomized and 8 observational studies, with a total of 6062 patients were included in this meta-analysis. FKB was associated with a significant reduction in myocardial infarction (RR 0.64, 95%CI 0.45-0.91, P=0.014). The results were similar between the 2 groups in major adverse cardiac events (MACE; RR 1.10, 95%CI 0.81-1.51, P=0.531), cardiac death (RR 0.64, 95%CI 0.66-1.59, P=0.902), target lesion revascularization (TLR; RR 1.25, 95%CI 0.83-1.88, P=0.294), target vessel revascularization (TVR; RR 1.18, 95%CI 0.80-1.75, P=0.396) and definite/probable stent thrombosis (ST; RR 1.07, 95%CI 0.61-1.87, P=0.819). Sub-analyses demonstrated that the results of MACE were similar between FKB and no FKB groups in patients with LM disease or with large SB bifurcation lesions (RR 0.99, 95%CI 0.66-1.48, P=0.954; RR 1.20, 95%CI 0.91-1.59, P=0.478, respectively).
FKB after DES stenting in MV of bifurcation lesion is associated with a lower risk of long-term myocardial infarction, but it fails to provide long-term benefit on overall clinical outcomes. Large, randomized controlled trials are warranted for further study.
CORONARY: PCI Outcomes