Key result
DK crush stenting cuts 1-year MACE ~62% vs. Culotte in distal left main bifurcations.
Why the study?
The comparative performance of double kissing (DK) crush versus Culotte stenting in unprotected left main coronary artery distal bifurcation lesions was not known.
Does double kissing crush stenting reduce 1-year major adverse cardiac events compared to Culotte stenting in patients with unprotected distal left main bifurcation lesions?
RCT (n=419)
Randomly assigned
Yes
Does double kissing crush stenting reduce 1-year major adverse cardiac events compared to Culotte stenting in patients with unprotected distal left main bifurcation lesions?
Absolute Event Rate: 6.2% vs 16.3%
p-value: p=<0.05
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Manipulation of the left main in this particular area is fraught with complications and relatively high rates of recurrent events.”
Double kissing crush stenting significantly reduces 1-year major adverse cardiac events compared to Culotte stenting for unprotected distal left main bifurcation lesions, primarily due to lower rates of target vessel revascularization.
OBJECTIVES: The study aimed to investigate the difference in major adverse cardiac event (MACE) at 1-year after double kissing (DK) crush versus Culotte stenting for unprotected left main coronary artery (UPLMCA) distal bifurcation lesions. BACKGROUND: DK crush and Culotte stenting were reported to be effective for treatment of coronary bifurcation lesions. However, their comparative performance in UPLMCA bifurcation lesions is not known. METHODS: A total of 419 patients with UPLMCA bifurcation lesions were randomly assigned to DK (n = 210) or Culotte (n = 209) treatment. The primary endpoint was the occurrence of a MACE at 1 year, including cardiac death, myocardial infarction, and target vessel revascularization (TVR). In-stent restenosis (ISR) at 8 months was secondary endpoint, and stent thrombosis (ST) served as a safety endpoint. Patients were stratified by SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) and NERS (New Risk Stratification) scores. RESULTS: Patients in the Culotte group had significant higher 1-year MACE rate (16.3%), mainly driven by increased TVR (11.0%), compared with the DK group (6.2% and 4.3%, respectively; all p < 0.05). ISR rate in side branch was 12.6% in the Culotte group and 6.8% in the DK group (p = 0.037). Definite ST rate was 1.0% in the Culotte group and 0% in the DK group (p = 0.248). Among patients with bifurcation angle ≥70°, NERS score ≥20, and SYNTAX score ≥23, the 1-year MACE rate in the DK group (3.8%, 9.2%, and 7.1%, respectively) was significantly different to those in the Culotte group(16.5%, 20.4%, and 18.9%, respectively; all p < 0.05). CONCLUSIONS: Culotte stenting for UPLMCA bifurcation lesions was associated with significantly increased MACEs, mainly due to the increased TVR. (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-00000151).
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Chen et al. (2013) conducted an RCT in Unprotected left main coronary artery (UPLMCA) distal bifurcation lesions (n=419). Double kissing (DK) crush stenting vs. Culotte stenting was evaluated on Occurrence of major adverse cardiac event (MACE) at 1 year, including cardiac death, myocardial infarction, and target vessel revascularization (TVR) (p=<0.05). Double kissing crush stenting significantly reduced the 1-year rate of major adverse cardiac events compared with Culotte stenting (6.2% vs 16.3%; p<0.05) in UPLMCA distal bifurcation lesions.
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