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Randomized Controlled Trial
. 2017 Feb;10(2):e004497.
doi: 10.1161/CIRCINTERVENTIONS.116.004497.

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)

Shao-Liang Chen  1 , Teguh Santoso  2 , Jun-Jie Zhang  2 , Fei Ye  2 , Ya-Wei Xu  2 , Qiang Fu  2 , Jing Kan  2 , Feng-Fu Zhang  2 , Yong Zhou  2 , Du-Jiang Xie  2 , Tak W Kwan  2
Affiliations
Randomized Controlled Trial

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)

Shao-Liang Chen et al. Circ Cardiovasc Interv. 2017 Feb.

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.

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Figures

Figure 1.
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.
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.
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.
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.
See this image and copyright information in PMC

References

    1. Steigen TK, Maeng M, Wiseth R, Erglis A, Kumsars I, Narbute I, Gunnes P, Mannsverk J, Meyerdierks O, Rotevatn S, Niemelä M, Kervinen K, Jensen JS, Galløe A, Nikus K, Vikman S, Ravkilde J, James S, Aarøe J, Ylitalo A, Helqvist S, Sjögren I, Thayssen P, Virtanen K, Puhakka M, Airaksinen J, Lassen JF, Thuesen L Nordic PCI Study Group. Randomized study on simple versus complex stenting of coronary artery bifurcation lesions: the Nordic bifurcation study. Circulation. 2006;114:1955–1961. doi: 10.1161/CIRCULATIONAHA.106.664920. - PubMed
    1. Hildick-Smith D, de Belder AJ, Cooter N, Curzen NP, Clayton TC, Oldroyd KG, Bennett L, Holmberg S, Cotton JM, Glennon PE, Thomas MR, Maccarthy PA, Baumbach A, Mulvihill NT, Henderson RA, Redwood SR, Starkey IR, Stables RH. Randomized trial of simple versus complex drug-eluting stenting for bifurcation lesions: the British Bifurcation Coronary Study: old, new, and evolving strategies. Circulation. 2010;121:1235–1243. doi: 10.1161/CIRCULATIONAHA.109.888297. - PubMed
    1. Colombo A, Bramucci E, Saccà S, Violini R, Lettieri C, Zanini R, Sheiban I, Paloscia L, Grube E, Schofer J, Bolognese L, Orlandi M, Niccoli G, Latib A, Airoldi F. Randomized study of the crush technique versus provisional side-branch stenting in true coronary bifurcations: the CACTUS (Coronary Bifurcations: Application of the Crushing Technique Using Sirolimus-Eluting Stents) study. Circulation. 2009;119:71–78. doi: 10.1161/CIRCULATIONAHA.108.808402. - PubMed
    1. Ferenc M, Gick M, Kienzle RP, Bestehorn HP, Werner KD, Comberg T, Kuebler P, Büttner HJ, Neumann FJ. Randomized trial on routine vs. provisional T-stenting in the treatment of de novo coronary bifurcation lesions. Eur Heart J. 2008;29:2859–2867. doi: 10.1093/eurheartj/ehn455. - PMC - PubMed
    1. Maeng M, Holm NR, Erglis A, Kumsars I, Niemelä M, Kervinen K, Jensen JS, Galløe A, Steigen TK, Wiseth R, Narbute I, Gunnes P, Mannsverk J, Meyerdierks O, Rotevatn S, Nikus K, Vikman S, Ravkilde J, James S, Aarøe J, Ylitalo A, Helqvist S, Sjögren I, Thayssen P, Virtanen K, Puhakka M, Airaksinen J, Christiansen EH, Lassen JF, Thuesen L Nordic-Baltic Percutaneous Coronary Intervention Study Group. Long-term results after simple versus complex stenting of coronary artery bifurcation lesions: Nordic Bifurcation Study 5-year follow-up results. J Am Coll Cardiol. 2013;62:30–34. doi: 10.1016/j.jacc.2013.04.015. - PubMed

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