Double Kissing Crush Versus Provisional Stenting for Left Main Distal Bifurcation Lesions
Key result
Planned DK crush cuts 1-year target lesion failure ~58% vs. provisional stenting in distal LM bifurcations.
- HR 0.42
- 95% CI 0.21 to 0.85
- P=0.02
- n=482
Why the study?
The double kissing (DK) crush 2-stent technique has never been compared with provisional stenting (PS) in patients with true distal left main bifurcation lesions.
Does a planned double kissing crush 2-stent technique reduce target lesion failure compared to provisional stenting in patients with true distal left main bifurcation lesions?
Population
482 patients with true distal LM bifurcation lesions from 26 centers in 5 countries
Comparison
Planned DK crush 2-stent technique vs provisional stenting
Design
Randomized multicenter international clinical trial
Follow-up
1 year
Authors
Discussion
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Implication
A planned double kissing crush 2-stent strategy significantly reduces 1-year target lesion failure compared to provisional stenting in patients with true distal left main bifurcation lesions.
Key Points
- To determine whether a planned double kissing crush two-stent technique is superior to provisional stenting in patients with true distal left main coronary bifurcation lesions.
- Multicenter randomized trial across 26 centers in 5 countries enrolling 482 patients with true distal left main bifurcation lesions (Medina 1,1,1 or 0,1,1) assigned to provisional stenting (n = 242) or double kissing crush stenting (n = 240) (ChiCTR-TRC-11001213).
- The primary endpoint was the 1-year composite rate of target lesion failure, defined as cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization, with routine angiographic follow-up at 13 months.
- Target lesion failure within 1 year occurred in 10.7% (26/242) of patients in the provisional stenting group versus 5.0% (12/240) in the double kissing crush group (hazard ratio: 0.42; 95% CI: 0.21 to 0.85; p = 0.02).
- Double kissing crush significantly decreased target vessel myocardial infarction (0.4% vs. 2.9%; p = 0.03) and definite or probable stent thrombosis (0.4% vs. 3.3%; p = 0.02) compared to provisional stenting.
- Rates of cardiac death did not differ significantly between groups, while clinically driven revascularization (3.8% vs. 7.9%; p = 0.06) and angiographic restenosis (7.1% vs. 14.6%; p = 0.10) numerically favored double kissing crush.
Study Design
Type
RCT (n=482)
Randomization
randomized
Multicenter
Yes
Structured PICO
Does a planned double kissing crush 2-stent technique reduce target lesion failure compared to provisional stenting in patients with true distal left main bifurcation lesions?
P
Population
482 patients with true distal left main bifurcation lesions followed for 1 year.
I
Intervention
Double kissing (DK) crush planned 2-stent technique
C
Comparator
Provisional stenting (PS)
O
Outcome
1-year composite rate of target lesion failure (TLF): cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularizationcomposite
Main Result
Hazard Ratio: 0.42 (95% CI 0.21–0.85)
Absolute Event Rate: 5% vs 10.7%
p-value: p=0.02
A planned double kissing crush 2-stent strategy significantly reduces 1-year target lesion failure compared to provisional stenting in patients with true distal left main bifurcation lesions.
Cite This Study
Chen et al. (2017) conducted an RCT in true distal left main (LM) bifurcation lesions (n=482). Double kissing (DK) crush stenting vs. Provisional stenting (PS) was evaluated on 1-year composite rate of target lesion failure (TLF): cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization (HR 0.42, 95% CI 0.21 to 0.85, p=0.02). A planned double kissing crush 2-stent technique reduced 1-year target lesion failure compared with provisional stenting in distal left main bifurcation lesions (5.0% vs 10.7%; HR 0.42; P=0.02).