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Comparison of outcomes between single long stent and overlapping stents: a meta-analysis of the literature

Vergleich der Ergebnisse zwischen langem Einzelstent und überlappenden Stents: Metaanalyse der Literatur

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Abstract

Objectives

There is no consensus on whether to treat diffuse coronary artery lesions with a single long stent (SLS) or by overlapping two or more stents (OLS). The goal of this review was to compare the outcomes of these two approaches through a meta-analysis of the literature.

Methods

We searched for relevant studies in MEDLINE, Scopus, EMBASE, Google Scholar, and the Cochrane Library. Our meta-analysis included 12 studies (n = 6414) that reported outcomes during the follow-up period.

Results

Individuals who received OLS had a greater risk of cardiac mortality and target lesion revascularization (TLR) than those who received SLS (RR: 1.51, CI: 1.03–2.21, p = 0.03, I2 = 0% and RR: 1.64, CI: 1.02–2.65, p = 0.04, I2 = 38%, respectively). The fluoroscopy period in the OLS group was longer than in the SLS group (SMD: 0.35, CI: 0.25–0.46, p < 0.01, I2 = 0%). more contrast volume was sued for the OLS group; however, there was substantial variability in the pooled analysis (I2 = 95%). In terms of all outcomes, there were no differences between stent generation types.

Conclusion

In the first meta-analysis of mainly observational data comparing OLS vs. SLS for long coronary lesions, OLS had higher rates of cardiac mortality and TLR as well as longer fluoroscopy times compared to SLS.

Zusammenfassung

Ziel

Es besteht kein Konsens darüber, ob diffuse Koronararterienläsionen mit einem singulären langen Stent (SLS) oder mit 2 oder mehr überlappenden Stents behandelt werden sollen. Ziel der vorliegenden Übersichtsarbeit war es, die Ergebnisse dieser beiden Ansätze anhand einer Metaanalyse der Literatur zu vergleichen.

Methoden

Dazu wurden relevante Studien in den Datenbanken MEDLINE, Scopus, EMBASE, Google Scholar und der Cochrane Library gesucht. Die Metaanalyse umfasste 12 Studien (n = 6414), in denen Ergebnisse aus der Nachsorgephase dargestellt wurden.

Ergebnisse

Personen, die mittels überlappender Stents behandelt wurden, wiesen ein höheres Risiko für kardial bedingte Mortalität und eine Revaskularisierung der Zielläsion auf als mit SLS behandelte Personen (relatives Risiko, RR: 1,51; Konfidenzintervall, KI: 1,03–2,21; p = 0,03; I2 = 0% bzw. RR: 1,64; KI: 1,02–2,65; p = 0,04; I2 = 38%). Die Durchleuchtungsphase war in der Gruppe mit überlappenden Stents länger als in der SLS-Gruppe (standardisierte Mittelwertdifferenz, SMD: 0,35; KI: 0,25–0,46; p < 0,01; I2 = 0%). In der Gruppe mit überlappenden Stents wurde mehr Kontrastmittel verwendet als in der SLS-Gruppe, jedoch bestand eine deutliche Variabilität in der gepoolten Analyse (I2 = 95%). In Bezug auf alle Ergebnisse fanden sich keine Unterschiede zwischen den Stentgenerationen.

Schlussfolgerung

In der ersten Metaanalyse von hauptsächlich aus Beobachtungsstudien stammenden Daten zum Vergleich von überlappenden Stents vs. SLS für lange Koronarläsionen wiesen Personen mit überlappenden Stents höhere Raten kardial bedingter Mortalität und einer Revaskularisierung der Zielläsion sowie längere Durchleuchtungsdauern als Personen mit SLS auf.

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Correspondence to Mert Ilker Hayıroğlu M.D..

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Conflict of interest

F. Şaylık, T. Çınar, M. Selçuk, V. Çiçek, M.I. Hayıroğlu and A.L. Orhan declare that they have no competing interests.

Because the study design was a meta-analysis, ethics committee or patient informed consent was not obtained.

Supplementary Information

Supplementary Figure 1.

Funnel plot for publication bias.

Supplementary Figure 2.

Forest plot showing the comparison of MACE between stent types subgroups.

Supplementary Figure 3.

Forest plot showing the comparison of all-cause death between stent types subgroups.

Supplementary Figure 4.

Forest plot showing the comparison of cardiac mortality between stent types subgroups.

Supplementary Figure 5.

Forest plot showing the comparison of myocardial infarction rates between stent types subgroups.

Supplementary Figure 6.

Forest plot showing the comparison of target lesion revascularization rates between stent types subgroups.

Supplementary Figure 7.

Forest plot showing the comparison of stent thrombosis rates between stent types subgroups.

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Şaylık, F., Çınar, T., Selçuk, M. et al. Comparison of outcomes between single long stent and overlapping stents: a meta-analysis of the literature. Herz 48, 376–383 (2023). https://doi.org/10.1007/s00059-022-05152-4

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  • DOI: https://doi.org/10.1007/s00059-022-05152-4

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