Randomised controlled trials (RCTs) that compared the effectiveness of percutaneous coronary intervention (PCI) by either double stenting of the main vessel and side branch (complex strategy) or single stenting of the main vessel only (simple strategy) with any PCI technique for coronary bifurcation lesions were eligible for inclusion. Studies were included regardless of the locations of the bifurcation lesions in the coronary artery tree and regardless of clinical presentation (acute or stable). RCTs that compared percutaneous coronary balloon angioplasty only versus PCI of the main vessel with provisional stenting of the side branch were excluded, as were studies that compared different stenting techniques of both bifurcation branches. The major outcomes were: death from any cause; myocardial infarction (Q wave and non-Q wave); stent thrombosis; and target lesion revascularisation.
The most commonly used double stenting technique was the crush technique; other techniques used included culotte and T-stenting. Most studies used sirolimus-eluting stents; one study paclitaxel-eluting stents. Platelet glycoprotein IIb/IIIa receptor inhibitors were used in none or up to 59% patients and final kissing balloon inflation was generally used. Mean patient age ranged from 60 to 67 years. Mean percentage of males ranged from 77.2% to 80.2%. Where reported, there was a history of myocardial infarction in 19.8% to 40% patients, previous PCI in 25.4% to 48% patients, prior coronary artery bypass graft in 3.4% to 9.3% patients, stable/unstable angina in 70.9% to 100% patients and diabetes mellitus in 12% to 41% patients. Two thirds of the studies excluded patients who had myocardial infarctions within the previous 24 hours. One third of studies excluded patients with reduced left ventricular function (less than 35%). Where reported, percentage of true bifurcation lesions ranged from 68% to 94%. Follow-up ranged from 6.4 to 14 months.
Two independent reviewers performed the selection and a third reviewer commented on any discrepancies.