Clinical Outcome of Double Kissing Crush Versus Provisional Stenting of Coronary Artery Bifurcation Lesions: The 5-Year Follow-Up Results From a Randomized and Multicenter DKCRUSH-II Study (Randomized Study on Double Kissing Crush Technique Versus Provisional Stenting Technique for Coronary Artery Bifurcation Lesions)

Abstract

Background: Provisional stenting is effective for anatomic simple bifurcation lesions. Double kissing crush stenting reduces the 1-year rate of target lesion revascularization. This study aimed to investigate the 5-year clinical results of the DKCRUSH-II study (Randomized Study on Double Kissing Crush Technique Versus Provisional Stenting Technique for Coronary Artery Bifurcation Lesions).

Methods and results: A total of 370 patients with coronary bifurcation lesions who were randomly assigned to either the double kissing crush or provisional stenting group in the DKCRUSH-II study were followed for 5 years. The primary end point was the occurrence of a major adverse cardiac event at 5 years. Patients were classified by simple and complex bifurcation lesions according to the DEFINITION criteria (Definitions and Impact of Complex Bifurcation Lesions on Clinical Outcomes After Percutaneous Coronary Intervention Using Drug-Eluting Stents). At 5 years, the major adverse cardiac event rate (23.8%) in the provisional stenting group was insignificantly different to that of the double kissing group (15.7%; P=0.051). However, the difference in the target lesion revascularization rate between 2 groups was sustained through the 5-year follow-up (16.2% versus 8.6%; P=0.027). The definite and probable stent thrombosis rate was 2.7% in each group (P=1.0). Complex bifurcation was associated with a higher rate of target lesion revascularization (21.6%) at 5 years compared with 11.1% in patients with a simple bifurcation (P=0.037), with an extremely high rate in the provisional stenting group (36.8% versus 12.5%, P=0.005) mainly because of final kissing balloon inflation (19.4% versus 5.2%; P=0.036).

Conclusions: The double kissing crush stenting technique for coronary bifurcation lesions is associated with a lower rate of target lesion revascularization. The optimal stenting approach based on the lesions' complexity may improve the revascularization for patients with complex bifurcations.

Clinical trial registration: URL: http://www.chictr.org. Unique identifier: ChiCTR-TRC-0000015.

Keywords: angiography; aspirin; coronary artery bifurcation lesions; double kissing crush; myocardial infarction; stents; thrombosis.

Figure 1.

Study flowchart of the DKCRUSH-II study (Randomized Study on Double Kissing Crush Technique Versus Provisional Stenting Technique for Coronary Artery Bifurcation Lesions). Eight months after an indexed stenting procedure, 91.6% of patients underwent angiographic follow-up. DK indicates double kissing.

Figure 2.

Kaplan–Meier analysis. The cumulative survival rate free from major adverse cardiac event (MACE; A) and target lesion revascularization (TLR; B) at a 5-year follow-up after the double kissing (DK) crush and provisional stenting techniques.

Figure 3.

Kaplan–Meier analysis. The cumulative survival rate from target lesion revascularization (TLR; A) and target vessel revascularization (TVR; B) at a 5-year follow-up in patients with complex and simple bifurcation lesions after stent implantation.

Figure 4.

Kaplan–Meier analysis. The survival rate free from major adverse cardiac event (MACE; A), target lesion revascularization (TLR; B), and target vessel revascularization (TVR; C) of patients with complex bifurcations after double kissing (DK) crush vs provisional stenting.