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DKCRUSH-II: Double Kissing Crush versus Provisional Stenting Technique for Treatment of Coronary Bifurcation Lesions Trial

Previous lines of investigations have shown that provisional side branch (SB) stenting is preferable to DK crush as it is associated with fewer complications. Which strategy could provide the best results, is still not known.

Addressing this issue, Shao-Liang Chen and co workers performed the present study to investigate the difference in major adverse cardiac events (MACE) at 12 months in patients with coronary bifurcation lesions after double kissing double crush (DK crush) or provisional stenting (PS) techniques.

The study population comprised of 370 unselected patients with coronary bifurcation lesions from 7 Asian centers. These patients were randomly assigned to either the DK or the PS group. If final results were found to be suboptimal, additional SB stenting in PS was required.

The patients were followed up for 12 months and primary and secondary endpoints were recorded. The primary end point included the occurrence of MACE at 12 months (cardiac death, myocardial infarction, or target vessel revascularization (TVR)) and the secondary end point included the angiographic restenosis at 8 months.

The following were the findings of the study:

  • 3 procedural occlusions of SB were reported in the PS group.
  • Significantly different angiographic restenosis rates in the main vessel and SB were observed the between the DK and the PS groups (table) at 8 months.

 

Main vessel

Side branch

DK group

3.8%

4.9%

PS group

9.7%

9.7%

  • Additional SB stenting in the PS group was required in 28.6% of lesions.
  • TVR in the DK group occurs less significantly than in the PS group (fig, p = 0.017). 

  • There differences in MACE and definite stent thrombosis between the DK (10.3% and 2.2%) and PS groups (17.3%, and 0.5%, p = 0.070 and p = 0.372, respectively) were nonsignificant.

In conclusion the study showed that DK crush was associated with a significant reduction of TLR and TVR in this unselected patient population. However, no significant difference in MACE was observed between the two groups. 

 


Source:J Am Coll Cardiol, 2011
Compiled and edited by the Editorial team and approved by Expert panel of CardioValens.com

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