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Circ Cardiovasc Interv. 2017 Feb;10(2). pii: 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).

Author information

1
From the Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, China (S.-L.C., J.-J.Z., F.Y., J.K., F.-F.Z.); Division of Cardiology, Medistra Hospital, University of Indonesia Medical School, Jakarta (T.S.); Division of Cardiology, Shanghai 10th People's Hospital, China (Y.-W.X.); Division of Cardiology, Xuzhou Central Hospital, China (Q.F.); Division of Cardiology, Zhangjiagang People's Hospital, China (Y.Z.); Division of Cardiology, Huainan Xinhua Hospital, China (D.-J.X.); and Division of Cardiology, Beth Israel Hospital, New York, NY (T.W.K.). chmengx@126.com.
2
From the Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, China (S.-L.C., J.-J.Z., F.Y., J.K., F.-F.Z.); Division of Cardiology, Medistra Hospital, University of Indonesia Medical School, Jakarta (T.S.); Division of Cardiology, Shanghai 10th People's Hospital, China (Y.-W.X.); Division of Cardiology, Xuzhou Central Hospital, China (Q.F.); Division of Cardiology, Zhangjiagang People's Hospital, China (Y.Z.); Division of Cardiology, Huainan Xinhua Hospital, China (D.-J.X.); and Division of Cardiology, Beth Israel Hospital, New York, NY (T.W.K.).

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

[Indexed for MEDLINE]
Free PMC Article

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