Minicrush vs T–stenting and Minimal Protrusion for Treatment of Complex Coronary Bifurcation Lesions: The Trex Registry Study

Background Optimal percutaneous coronary intervention (PCI) techniques for complex bifurcation lesions remain a subject of debate. Intentional two–stent strategies are widely employed, but comparative clinical effectiveness between different methods requires further investigation. This study aimed to compare the clinical efficacy of two prevalent two–stent techniques: The Minicrush and the T–stenting and Small Protrusion (TAP) methods, focusing on target lesion failure (TLF) and major adverse cardiac events (MACE) in patients undergoing complex bifurcation PCI. Methods This observational, multicenter study analysed data from a total of 469 patients with intentional two–stent treatment strategies identified from 601 screened procedures. Patients were divided into two cohorts: The Minicrush group (n=257) and the TAP group (n=212). Procedural details and clinical outcomes were meticulously collected and compared, utilizing both standard statistical and Bayesian analyses for long–term data. Results Technical and procedural success rates were high and comparable between the groups (98.5% and 95%, respectively). In–hospital MACE occurred in 3.8% of patients, with only two cases of acute stent thrombosis recorded, both in the TAP group. The primary outcome, TLF, occurred in 49 patients (10.4%) overall, with no statistically significant differences observed between the groups during the follow–up period using traditional statistical methods (8.2% in Minicrush vs. 13.2% in TAP; p=0.08). The odds ratios consistently showed a trend towards higher TLF in the TAP group, but without reaching statistical significance (e.g., 5 years: OR 1.67, 95% CI 0.86–3.32, p=0.113). However, Bayesian analysis provided strong evidence (posterior probabilities of 94% at 1 year and 98% at 5 and 10 years) suggesting a consistently higher long–term hazard of TLF in the TAP method compared to the Minicrush method. Secondary outcomes (MACE) were nearly identical between the groups at all time points (23% vs. 23.6%, p=0.87). Conclusions In patients undergoing complex bifurcation PCI, both the Minicrush and TAP techniques demonstrated high success rates and comparable MACE outcomes. While standard statistical analysis did not show a significant difference in TLF rates, Bayesian analysis suggests a strong probability that the TAP technique is associated with a higher long–term risk of target lesion failure compared to the Minicrush technique.