Long-Term Evaluation of Revascularization Strategies for Medina 0.1.0 Left Main Bifurcation Lesions: The LM-CROSSOVER Registry

Comparing cross-over stenting and focal ostial stenting for ostial left anterior descending coronary artery lesions: a systematic review and meta-analysis

BACKGROUND

The ideal revascularization approach for ostial left anterior descending coronary artery (L.A.D.) lesions continues to be a matter of debate. Two primary stenting strategies are often contemplated for managing these lesions: focal ostial stenting (F.O.S.) and the provisional strategy, alternatively termed cross-over stenting (C.O.S.) from the LM to the L.A.D. artery.

AIM

Our objective is to assess the efficacy of C.O.S. vs. F.O.S. techniques in patients with ostial L.A.D. lesions who underwent percutaneous coronary intervention (P.C.I.).

METHODS

We systematically searched five electronic databases to identify relevant studies. The data was pooled as odds ratio (O.R.) with its 95% confidence interval (C.I.) using the DerSimonian-Laird random effect model in STATA 17 MP. Significance was determined by a p-value > 0.05 between intervention subgroups.

RESULTS

Nine articles with a total of 1492 patients were included in the meta-analysis. The pooled O.R. for Major Adverse Cardiovascular Events (MACE) was 0.88 (95% C.I. [0.39, 1.99], P = 0.76), indicating comparable rates between F.O.S. and C.O.S. For all-cause death, the O.R. was 1.46 (95% C.I. [0.53, 4.02], P = 0.46), with no significant differences between the compared techniques. Cardiovascular death showed no preference between treatments (O.R.=0.99, 95% C.I. [0.30, 3.31], P = 0.99), and similarly for myocardial infarction (O.R.=0.74, 95% C.I. [0.38, 1.44], P = 0.37).

CONCLUSION

Our meta-analysis comparing C.O.S. and F.O.S. for L.A.D. lesions revealed similar efficacy in clinical and angiographic outcomes.