A randomized clinical study comparing double kissing crush with provisional stenting for treatment of coronary bifurcation lesions: results from the DKCRUSH-II (Double Kissing Crush versus Provisional Stenting Technique for Treatment of Coronary Bifurcation Lesions) trial.

Abstract

OBJECTIVES:

The present study aimed to investigate the difference in major adverse cardiac events (MACE) at 12 months in patients with coronary bifurcation lesions after double kissing double crush (DK crush) or provisional stenting (PS) techniques.

BACKGROUND:

Provisional side branch (SB) stenting is preferable to DK crush because it has been associated with fewer complications. It is unknown which strategy would provide the best results.

METHODS:

From April 2007 to June 2009, 370 unselected patients with coronary bifurcation lesions from 7 Asian centers were randomly assigned to either the DK or the PS group. Additional SB stenting in PS was required if final results were suboptimal. The primary end point was the occurrence of MACE at 12 months, including cardiac death, myocardial infarction, or target vessel revascularization (TVR). Secondary end point was the angiographic restenosis at 8 months.

RESULTS:

There were 3 procedural occlusions of SB in the PS group. At 8 months, angiographic restenosis rates in the main vessel and SB were significantly different between the DK (3.8% and 4.9%) and the PS groups (9.7% and 22.2%, p = 0.036 and p < 0.001, respectively). Additional SB stenting in the PS group was required in 28.6% of lesions. TVR was 6.5% in the DK group, occurring significantly less often than in the PS group (14.6%, p = 0.017). There were nonsignificant differences in MACE and definite stent thrombosis between the DK (10.3% and 2.2%) and PS groups (17.3%, and 0.5%, p = 0.070 and p = 0.372, respectively).

CONCLUSIONS:

DK crush was associated with a significant reduction of TLR and TVR in this unselected patient population. However, there was no significant difference in MACE between DK and the PS groups. (Randomized Study on DK Crush Technique Versus Provisional Stenting Technique for Coronary Artery Bifurcation Lesions; ChicTR-TRC-00000015).

• Authors: Shao-Liang Chen, Teguh Santoso, Jun-Jie Zhang, Fei Ye, Ya-Wei Xu, Qiang Fu, Jing Kan, Chitprapai Paiboon, Yong Zhou, Shi-Qing Ding, Tak W Kwan
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 57 Issue 8 Pg. 914-20 (Feb 22 2011) ISSN: 1558-3597 [Electronic] United States
• PMID: 21329837 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Sirolimus

Topics

• Age Factors
• Aged
• Angioplasty, Balloon, Coronary (methods, mortality)
• China
• Coronary Angiography (methods)
• Coronary Restenosis (diagnostic imaging, mortality, therapy)
• Coronary Stenosis (diagnostic imaging, mortality, therapy)
• Drug-Eluting Stents
• Female
• Follow-Up Studies
• Hospital Mortality (trends)
• Humans
• Male
• Middle Aged
• Prospective Studies
• Prosthesis Failure
• Risk Assessment
• Severity of Illness Index
• Sex Factors
• Sirolimus (pharmacology)
• Survival Analysis
• Time Factors
• Treatment Outcome