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

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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.

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