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

We thank Güner et al1 for their interest in our paper2 and important comments. The authors of the letter expressed some concerns regarding the heterogeneity of patients’ bifurcation lesion complexity, interventional approaches, and background medical treatment in the trials included in our meta-analysis, and we thank them for the opportunity to clarify our analysis.

We strongly agree that proximal optimisation technique (POT) is an essential step in coronary bifurcation lesion treatment, recommended by the European Bifurcation Club (EBC) in case of either a provisional stenting strategy or an upfront 2-stent technique34. Although POT was introduced in the late 2000s5 and has since become a gold standard of bifurcation lesion treatment, it was not obligatory according to the protocols of the majority of randomised controlled trials (RCTs) included in our meta-analysis2. Therefore, we performed a sensitivity analysis including only those trials requiring POT. The results of this sensitivity analysis, presented in the supplementary materials of our paper, were completely consistent with the primary analysis.

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