IVUS or Angiography Guidance for Percutaneous Coronary Intervention in Complex Coronary Bifurcation Lesions
View Full PaperSupports IVUS-guided PCI as preferred for complex bifurcation lesions; extends RCT evidence to DK crush stenting in this high-risk anatomy.
Key result
IVUS-guided PCI significantly reduced target vessel failure at 1 year compared to angiography-guided PCI in complex coronary bifurcation lesions (6.1% vs 14.7%; HR 0.40; 95% CI 0.23-0.71; P=0.002).
DKCRUSH-VIII has reported — post the first read.
DKCRUSH-VIII is a 556-patient multicenter randomized trial from China comparing IVUS-guided versus angiography-guided double kissing (DK) crush stenting for complex coronary bifurcation lesions. At 1 year, IVUS guidance reduced target vessel failure from 14.7% to 6.1% (HR 0.40, p=0.002), driven by reductions in target vessel MI and revascularization. An accompanying JACC editorial by Gregg Stone and Gaurav Arora argued the debate should shift from whether to use intravascular imaging to which modality and how best to use it. Quote supply from the source material is limited, with most available quotes coming from the editorial and prior DKCRUSH-V coverage rather than direct DKCRUSH-VIII reactions.
RCT (n=555)
Open-label
1:1
Yes
Does IVUS-guided PCI reduce target vessel failure compared to angiography-guided PCI in patients with complex coronary bifurcation lesions?
IVUS-guided PCI significantly reduces target vessel failure at 1 year compared to angiography-guided PCI in complex coronary bifurcation lesions treated with the DK crush technique.
Effect estimate: HR 0.40 (95% CI 0.23-0.71)
Absolute Event Rate: 6.1% vs 14.7%
p-value: p=0.002
One of several IVUS trials at ACC.26; positive result contributing to overall signal for imaging in complex PCI; discussed in context of neutral trials.
Gao et al. (Sun,) conducted a rct in Complex coronary bifurcation lesions (n=555). IVUS-guided PCI vs. Angiography-guided PCI was evaluated on Composite of target vessel failure (cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularization) (HR 0.40, 95% CI 0.23-0.71, p=0.002). IVUS-guided PCI significantly reduced target vessel failure at 1 year compared to angiography-guided PCI in complex coronary bifurcation lesions (6.1% vs 14.7%; HR 0.40; 95% CI 0.23-0.71; P=0.002).
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