A Randomized Clinical Study Comparing Double Kissing Crush With Provisional Stenting for Treatment of Coronary Bifurcation Lesions
Key result
DK crush stenting fails to significantly reduce 12-month MACE over provisional stenting.
- P=0.070
- n=370
Why the study?
It is unknown which stenting strategy, double kissing double crush or provisional stenting, provides better outcomes for coronary bifurcation lesions.
Does the double kissing crush technique reduce MACE at 12 months compared to provisional stenting in patients with coronary bifurcation lesions?
Population
370 unselected patients with coronary bifurcation lesions from 7 Asian centers
Comparison
Double kissing double crush (DK crush) vs provisional stenting (PS) with additional side branch stenting if needed
Design
Randomized clinical trial
Follow-up
12 months
Authors
Discussion
Loading...
Member takes
Implication
DK crush stenting for coronary bifurcation lesions significantly reduces target vessel revascularization and angiographic restenosis compared to provisional stenting, though it did not significantly reduce overall MACE at 12 months.
Key Points
- To evaluate differences in 12-month major adverse cardiac events and 8-month angiographic restenosis between double kissing crush and provisional stenting in coronary bifurcation lesions.
- Multicenter randomized trial of 370 unselected patients with coronary bifurcation lesions across 7 Asian centers from April 2007 to June 2009 (ChicTR-TRC-00000015).
- Patients were randomly allocated to either the double kissing (DK) crush technique or provisional stenting (PS), with additional side branch stenting permitted for suboptimal PS outcomes.
- At 12 months, the primary endpoint of major adverse cardiac events occurred in 10.3% of the DK group versus 17.3% of the PS group (p = 0.070).
- Target vessel revascularization at 12 months occurred significantly less often with DK crush (6.5%) than provisional stenting (14.6%, p = 0.017), with definite stent thrombosis observed in 2.2% versus 0.5% (p = 0.372).
- At 8 months, angiographic restenosis was significantly lower in the DK group compared to the PS group in both the main vessel (3.8% vs. 9.7%, p = 0.036) and the side branch (4.9% vs. 22.2%, p < 0.001).
Study Design
Type
RCT (n=370)
Randomization
randomly assigned
Multicenter
Yes
Structured PICO
Does the double kissing crush technique reduce MACE at 12 months compared to provisional stenting in patients with coronary bifurcation lesions?
P
Population
370 unselected patients with coronary bifurcation lesions from 7 Asian centers, followed for 12 months.
I
Intervention
Double kissing double crush (DK crush) stenting technique
C
Comparator
Provisional stenting (PS) technique, with additional side branch stenting if final results were suboptimal
O
Outcome
Major adverse cardiac events (MACE) at 12 months, including cardiac death, myocardial infarction, or target vessel revascularization (TVR)composite
Main Result
Absolute Event Rate: 10.3% vs 17.3%
p-value: p=0.070
DK crush stenting for coronary bifurcation lesions significantly reduces target vessel revascularization and angiographic restenosis compared to provisional stenting, though it did not significantly reduce overall MACE at 12 months.
Cite This Study
Chen et al. (2011) conducted an RCT in Coronary bifurcation lesions (n=370). Double kissing double crush (DK crush) stenting vs. Provisional stenting (PS) was evaluated on Occurrence of MACE at 12 months, including cardiac death, myocardial infarction, or target vessel revascularization (TVR) (p=0.070). Double kissing crush stenting did not significantly reduce major adverse cardiac events at 12 months compared to provisional stenting (10.3% vs 17.3%; P=0.070).