Coronary bifurcation lesions: To stent one branch or both? A meta-analysis of patients treated with drug eluting stents

Giampaolo Niccoli, Giuseppe Ferrante, Italo Porto, Francesco Burzotta, Antonio M. Leone, Rocco Mongiardo, Mario A. Mazzari, Carlo Trani, Antonio G. Rebuzzi, Filippo Crea

Research output: Contribution to journalArticlepeer-review


Background: In the treatment of coronary bifurcation lesions (CBL), with drug eluting stents (DES), we sought to compare angiographic and clinical outcomes of a simple strategy of stenting main vessel only with balloon dilatation of the side branch with a complex strategy of stenting both branches. Methods: We performed a meta-analysis of six studies, randomized (three) or prospective observational (three), including 963 patients, that directly compared the simple strategy to the complex strategy, in the treatment of CBL with DES. Results: Final minimal lumen diameter (MLD) of the side branch was significantly smaller in the simple strategy group [WMD - 0.50 mm, 95% CI (- 0.76, - 0.24), p <0.00001]. The risk of main vessel restenosis [RR 0.66, 95% CI (0.38-1.17), p = 0.16], side branch restenosis [RR 0.62, 95% CI (0.24-1.56), p = 0.31], follow up death [RR 0.60, 95% CI (0.19-1.86), p = 0.38], follow up myocardial infarction [RR 0.71, 95% CI (0.46-1.10), p = 0.13], or target vessel revascularization [RR 0.90, 95% CI (0.56-1.46), p = 0.67] was similar between the two strategies. The simple strategy showed a trend to a lower risk of early myocardial infarction [RR 0.65, 95% CI (0.41-1.05), p = 0.08]. Conclusion: In the treatment of unselected CBL with DES, the complex strategy does not penalize angiographic and clinical outcomes compared to the simple strategy. Further randomized studies are needed to assess the benefit of simple or complex strategy in the treatment of specific subsets of bifurcated lesions.

Original languageEnglish
Pages (from-to)80-91
Number of pages12
JournalInternational Journal of Cardiology
Issue number1
Publication statusPublished - Feb 18 2010


  • Coronary bifurcation lesions
  • Drug eluting stent
  • Meta-analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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