Letter: Cardiovascular outcomes after 2-stent or stepwise provisional techniques for coronary bifurcation lesions

We have recently read, with great interest, the article by Bujak et al entitled ‘‘Clinical outcomes following different stenting techniques for coronary bifurcation lesions: a systematic review and network meta-analysis of randomised controlled trials’’1. We thank the authors for their comprehensive and meticulous meta-Âanalysis, which included 24 randomised clinical trials (RCTs; 6,890 patients) comparing the clinical outcomes of different revascularisation strategies for the management of coronary bifurcation lesions (CBLs). However, we believe several major drawbacks need to be addressed.

The reasons for our concern are as follows:

First, several investigators reported that the proximal optimisation technique (POT) was associated with a reduction in major cardiovascular events or stent thrombosis. Potential differences in the use of POT23, regardless of the characteristics of the CBLs and the application of the technique, may have affected the results of the RCTs.

Second, the antiplatelet treatment regimen after bifurcation stenting varied among the RCTs in this meta-analysis. In this meta-analysis, several RCTs included ticagrelor and prasugrel as antiplatelet choices, while most other relatively older studies used clopidogrel and ticlopidine1. A recent network meta-analysis showed...