| Institution: | 1. Nanjing First Hospital, Nanjing Medical University, Nanjing, China;2. Beijing Fuwai Cardiovascular Hospital, Beijing, China;3. Northen Hospital, Shenyang, China;4. San Giovanni Battista Hospital, University of Turin, Turin, Italy;6. Beth Israel Hospital, New York, New York;5. Bangkok General Hospital, Bangkok, Thailand;7. Mount Sinai Hospital, New York, New York;11. Shanghai 10th Hospital, Shanghai, China;12. Daqing Oil General Hospital, Daqing, China;8. Jiangxi Provincial People’s Hospital, Nanchang, China;10. Shanghai Ruijin Hospital, Shanghai, China;9. Xijing Hospital, Xi’an 4th Military Medical University, Xi’an, China;71. Xia’Men Zhongshan Hospital, Xia’Men, China;112. Medistra Hospital, University of Indonesia Medical School, Jakarta, Indonesia;123. Xi’an Communication University Hospital, Xi’an, China;84. Haarbin Medical University 1st Hospital, Haarbin, China;106. Cardiovascular Research Foundation, New York, New York |
| Abstract: | ObjectivesThe present study aimed to investigate the difference in major adverse cardiac events (MACE) at 3 years after double-kissing (DK) crush versus culotte stenting for unprotected left main distal bifurcation lesions (LMDBLs).BackgroundThe multicenter and randomized DKCRUSH-III (Comparison of double kissing crush versus culotte stenting for unprotected distal left main bifurcation lesions: results from a multicenter, randomized, prospective study) showed that DK crush stenting was associated with fewer MACE at 1-year follow-up in patients with LMDBLs compared with culotte stenting. Here, we report the 3-year clinical outcome of the DKCRUSH-III study.MethodsA total of 419 patients with LMDBLs who were randomly assigned to either the DK crush or culotte group in the DKCRUSH-III study were followed for 3 year. The primary endpoint was the occurrence of a MACE at 3 years. Stent thrombosis (ST) was the safety endpoint. Patients were classified by simple and complex LMDBLs according to the DEFINITION (Definition and Impact of Complex Bifurcation Lesions on Clinical Outcomes After Percutaneous Coronary Intervention Using Drug-Eluting Stents) study criteria.ResultsAt 3 years, MACE occurred in 49 patients the culotte group and in 17 patients in the DK crush group (cumulative event rates of 23.7% and 8.2%, respectively; p < 0.001), mainly driven by increased myocardial infarction (8.2% vs. 3.4%, respectively; p = 0.037) and target-vessel revascularization (18.8% vs. 5.8%, respectively; p < 0.001) between groups. Definite ST rate was 3.4% in the culotte group and 0% in the DK crush group (p = 0.007). Complex LMDBLs were associated with a higher rate of MACE (35.3%) at 3 years compared with a rate of 8.1% in patients with simple LMDBLs (p < 0.001), with an extremely higher rate in the culotte group (51.5% vs. 15.1%, p < 0.001).ConclusionsCulotte stenting for LMDBLs was associated with significantly increased rates of MACE and ST. (Double Kissing DK] Crush Versus Culotte Stenting for the Treatment of Unprotected Distal Left Main Bifurcation Lesions: DKCRUSH-III, a Multicenter Randomized Study Comparing Double-Stent Techniques; ChiCTR-TRC-11001877) |
