Outcomes in provisional one-stent versus dedicated two-stent coronary bifurcation stenting techniques: a systematic review and meta-analysis.

BACKGROUND

The optimal long-term strategy for coronary bifurcation PCI remains debated. Earlier meta-analyses limited to long-term data suggested better outcomes with a provisional approach versus routine two-stent techniques.

METHODS

We conducted an updated, comprehensive meta-analysis of randomized controlled trials comparing provisional versus two-stent strategies. MEDLINE, Embase, and the Cochrane Library were searched through September 2025. Fifteen RCTs (n = 6978) met inclusion criteria. Using Stata 16.1, random-effects (DerSimonian-Laird) risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for prespecified outcomes.

RESULTS

Relative risks (95% CIs) for provisional vs two-stent were: all-cause mortality 0.97 (0.72-1.30); cardiovascular mortality 0.98 (0.68-1.40); myocardial infarction 0.86 (0.62-1.19); target lesion revascularization 1.07 (0.80-1.44); stent thrombosis 1.36 (0.81-2.29); and MACE 1.27 (0.81-1.99). Across endpoints, pooled estimates did not show statistically significant differences between strategies.

CONCLUSION

In this updated synthesis of randomized trials, the available evidence did not demonstrate clear superiority of either provisional or two-stent strategies for major clinical outcomes. Unlike prior long-term-only analyses, we did not observe higher mortality or myocardial infarction with two-stent approaches. Technique selection should remain individualized according to lesion anatomy, procedural complexity, and operator expertise. These findings should not be interpreted as proof of equivalence or non-inferiority. Trial registration CRD420251167534.