Key result
DK-crush technique cuts cardiac death ~66% vs provisional stenting in unprotected left-main bifurcation PCI.
Why the study?
Provisional stenting was considered the preferred technique for left-main bifurcation PCI, but recent studies showed potential advantages of double kissing (DK)-crush over other strategies.
Does the DK-crush stenting technique reduce adverse clinical events compared to provisional stenting and other techniques in patients undergoing unprotected left-main bifurcation PCI?
Meta-Analysis (n=2,364)
Does the DK-crush stenting technique reduce adverse clinical events compared to provisional stenting and other techniques in patients undergoing unprotected left-main bifurcation PCI?
Relative Risk: 0.34 (95% CI 0.17–0.7)
p-value: p=<.01
In a network meta-analysis, the DK-crush technique was associated with significantly lower rates of cardiac death, myocardial infarction, and revascularization compared to provisional stenting for unprotected left main bifurcation PCI.
DK-crush may be preferred for unprotected LM bifurcation PCI; challenges provisional stenting as default and extends comparative evidence.
OBJECTIVES: We aimed to assess which bifurcation technique performs best in unprotected left-main (LM) percutaneous coronary intervention (PCI). BACKGROUND: Provisional stenting was considered the preferred technique for LM bifurcation PCI due to the supposed lower risks of thrombosis and restenosis. However, recent studies showed potential advantages of double kissing (DK)-crush technique over the other strategies. METHODS: We performed a frequentist network meta-analysis comparing different stenting techniques in the setting of LM bifurcation. PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov were searched. Both randomized clinical trials and non-randomized clinical trials were considered eligible for inclusion. Incidence rate ratios (IRRs) were computed using a random-effects model for death, cardiac death, myocardial infarction, target-vessel revascularization, target-lesion revascularization, and stent thrombosis, including 95% confidence intervals (CIs). RESULTS: A total of 10 studies (2364 patients) were included. Compared with provisional stenting, DK-crush was associated with fewer cardiac deaths (IRR, 0.34; 95% CI, 0.17-0.70; P<.01), myocardial infarctions (IRR, 0.19; 95% CI, 0.08-0.44; P<.001), stent thromboses (IRR, 0.31; 95% CI, 0.14-0.69; P<.01), target-vessel revascularizations (IRR, 0.25; 95% CI, 0.14-0.46; P<.001), and target-lesion revascularizations (IRR, 0.25; 95% CI, 0.14-0.46; P<.001). DK-crush was also associated with a lower risk of myocardial infarction (IRR, 0.19; 95% CI, 0.05-0.76; P=.02) when compared with standard crush and lower risk of target-lesion revascularization when compared with culotte (IRR, 0.32; 95% CI, 0.12-0.83; P=.02) and crush (IRR, 0.07; 95% CI, 0.02-0.28; P<.001). CONCLUSIONS: DK-crush is the best technique for unprotected LM bifurcation PCI.
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Vescovo et al. (2022) conducted a meta-analysis in Unprotected left-main (LM) bifurcation disease (n=2,364). Double kissing (DK)-crush technique vs. Provisional stenting was evaluated on Cardiac death (IRR 0.34, 95% CI 0.17-0.70, p=<.01). Compared with provisional stenting, the DK-crush technique significantly reduced cardiac death (IRR 0.34; 95% CI 0.17-0.70; P<.01) in unprotected left-main bifurcation PCI.
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