TY - JOUR
T1 - Double Kissing Crush Versus Provisional Stenting for Left Main Distal Bifurcation Lesions
T2 - DKCRUSH-V Randomized Trial
AU - Chen, Shao Liang
AU - Zhang, Jue Jie
AU - Han, Yaling
AU - Kan, Jing
AU - Chen, Lianglong
AU - Qiu, Chunguang
AU - Jiang, Tiemin
AU - Tao, Ling
AU - Zeng, Hesong
AU - Li, Li
AU - Xia, Yong
AU - Gao, Chuanyu
AU - Santoso, Teguh
AU - Paiboon, Chootopol
AU - Wang, Yan
AU - Kwan, Tak W.
AU - Ye, Fei
AU - Tian, Nailiang
AU - Liu, Zhizhong
AU - Lin, Song
AU - Lu, Chengzhi
AU - Wen, Shangyu
AU - Hong, Lang
AU - Zhang, Qi
AU - Sheiban, Imad
AU - Xu, Yawei
AU - Wang, Lefeng
AU - Rab, Tanveer S.
AU - Li, Zhanquan
AU - Cheng, Guanchang
AU - Cui, Lianqun
AU - Leon, Martin B.
AU - Stone, Gregg W.
N1 - Funding Information:
The design of the DKCRUSH-V trial (Double Kissing and Double Crush Versus Provisional T Stenting Technique for the Treatment of Unprotected Distal Left Main True Bifurcation Lesions: A Randomized, International, Multi-Center Clinical Trial) has been previously described (19) . The study organization, participating sites, and investigators are listed in the Online Appendix . The protocol was designed by the steering committee and approved by the ethics committee at each participating center. The trial was funded by grants from the National Science Foundation of China (NSFC 91639303 and NSFC 81770441), and jointly supported by Nanjing Municipal Medical Development Project, Microport (Shanghai, China), Abbott Vascular (Santa Clara, CA, US), and Medtronic (Santa Rosa, California). The funding sources did not participate in the design or conduct of the study, analysis, or interpretation of the data, or the decision to submit the manuscript for publication. The authors had access to the complete database, vouch for the accuracy and integrity of the data and all analyses, prepared the manuscript, and controlled the decision to publish. The study is registered with the Chinese Clinical Trial Registry ( ChiCTR-TRC-11001213 ).
Funding Information:
The DKCRUSH-V trial was funded by a grant from the National Science Foundation of China (Funding no.: NSFC 91639303, NSFC 81770441), and jointly supported by Nanjing Municipal Medical Development Project, Microport (Shanghai, China), Abbott Vascular (Santa Clara, California), and Medtronic (Santa Rosa, California). The authors have reported that they have no relationships relevant to the contents of this paper to disclose. The first 2 authors contributed equally to this work.
Publisher Copyright:
© 2017 American College of Cardiology Foundation
PY - 2017/11/28
Y1 - 2017/11/28
N2 - Background Provisional stenting (PS) is the most common technique used to treat distal left main (LM) bifurcation lesions in patients with unprotected LM coronary artery disease undergoing percutaneous coronary intervention. The double kissing (DK) crush planned 2-stent technique has been shown to improve clinical outcomes in non-LM bifurcations compared with PS, and in LM bifurcations compared with culotte stenting, but has never been compared with PS in LM bifurcation lesions. Objectives The authors sought to determine whether a planned DK crush 2-stent technique is superior to PS for patients with true distal LM bifurcation lesions. Methods The authors randomized 482 patients from 26 centers in 5 countries with true distal LM bifurcation lesions (Medina 1,1,1 or 0,1,1) to PS (n = 242) or DK crush stenting (n = 240). The primary endpoint was the 1-year composite rate of target lesion failure (TLF): cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization. Routine 13-month angiographic follow-up was scheduled after ascertainment of the primary endpoint. Results TLF within 1 year occurred in 26 patients (10.7%) assigned to PS, and in 12 patients (5.0%) assigned to DK crush (hazard ratio: 0.42; 95% confidence interval: 0.21 to 0.85; p = 0.02). Compared with PS, DK crush also resulted in lower rates of target vessel myocardial infarction I (2.9% vs. 0.4%; p = 0.03) and definite or probable stent thrombosis (3.3% vs. 0.4%; p = 0.02). Clinically driven target lesion revascularization (7.9% vs. 3.8%; p = 0.06) and angiographic restenosis within the LM complex (14.6% vs. 7.1%; p = 0.10) also tended to be less frequent with DK crush compared with PS. There was no significant difference in cardiac death between the groups. Conclusions In the present multicenter randomized trial, percutaneous coronary intervention of true distal LM bifurcation lesions using a planned DK crush 2-stent strategy resulted in a lower rate of TLF at 1 year than a PS strategy.
AB - Background Provisional stenting (PS) is the most common technique used to treat distal left main (LM) bifurcation lesions in patients with unprotected LM coronary artery disease undergoing percutaneous coronary intervention. The double kissing (DK) crush planned 2-stent technique has been shown to improve clinical outcomes in non-LM bifurcations compared with PS, and in LM bifurcations compared with culotte stenting, but has never been compared with PS in LM bifurcation lesions. Objectives The authors sought to determine whether a planned DK crush 2-stent technique is superior to PS for patients with true distal LM bifurcation lesions. Methods The authors randomized 482 patients from 26 centers in 5 countries with true distal LM bifurcation lesions (Medina 1,1,1 or 0,1,1) to PS (n = 242) or DK crush stenting (n = 240). The primary endpoint was the 1-year composite rate of target lesion failure (TLF): cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization. Routine 13-month angiographic follow-up was scheduled after ascertainment of the primary endpoint. Results TLF within 1 year occurred in 26 patients (10.7%) assigned to PS, and in 12 patients (5.0%) assigned to DK crush (hazard ratio: 0.42; 95% confidence interval: 0.21 to 0.85; p = 0.02). Compared with PS, DK crush also resulted in lower rates of target vessel myocardial infarction I (2.9% vs. 0.4%; p = 0.03) and definite or probable stent thrombosis (3.3% vs. 0.4%; p = 0.02). Clinically driven target lesion revascularization (7.9% vs. 3.8%; p = 0.06) and angiographic restenosis within the LM complex (14.6% vs. 7.1%; p = 0.10) also tended to be less frequent with DK crush compared with PS. There was no significant difference in cardiac death between the groups. Conclusions In the present multicenter randomized trial, percutaneous coronary intervention of true distal LM bifurcation lesions using a planned DK crush 2-stent strategy resulted in a lower rate of TLF at 1 year than a PS strategy.
KW - double kissing crush
KW - left main bifurcation lesions
KW - prognosis
KW - provisional stenting
UR - http://www.scopus.com/inward/record.url?scp=85033690174&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2017.09.1066
DO - 10.1016/j.jacc.2017.09.1066
M3 - Article
C2 - 29096915
AN - SCOPUS:85033690174
SN - 0735-1097
VL - 70
SP - 2605
EP - 2617
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 21
ER -