Optimal Stenting Technique for Lesions at the Ostium of the Left Anterior Descending Artery: A Systematic Review and Meta-Analysis.

BACKGROUND

Ostial lesions of the left anterior descending (LAD) artery present unique challenges for interventional cardiologists. The two principal techniques for percutaneous coronary intervention (PCI) of ostial LAD lesions are ostial stenting (OS) and cross-over stenting (CS). Current data comparing the efficacy of these techniques have been mixed.

AIMS: Determine whether there are differences in efficacy between CS and OS for PCI of ostial LAD lesions.

METHODS

We performed a systematic review of studies comparing CS and OS techniques regarding long-term outcomes (≥ 1 year). Using the Mantel-Haenszel random effects model, we computed relative risk (RR) with 95% confidence intervals (CI) for major adverse cardiovascular events (MACE), death, myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis (ST) between CS and OS groups. For significant outcomes, a subgroup analysis was performed, dividing studies by percent intravascular ultrasound (IVUS) use (> 50% vs. ≤ 50%).

RESULTS

Eight cohort studies with a total of 1448 participants were included in the meta-analysis. CS was favored with respect to TLR (5.5% vs. 10.6%; RR 0.57, 95% CI 0.34-0.95, p = 0.03) and ST (0.9% vs. 4.3%; RR 0.34, 95% CI 0.13-0.93, p = 0.04). There was no significant association between stenting technique with MACE, death or MI, though significant heterogeneity was observed in analyses of these outcomes. In subgroup analysis, significant association favoring CS in TLR and ST was observed in the lower IVUS use but not in the higher IVUS use subgroup.

CONCLUSION

Our meta-analysis suggests that CS is associated with lower long-term risk for TLR and ST compared to OS in PCI of ostial LAD lesions, especially if intravascular imaging is not available.