Original title: Randomized Comparison of FFR-Guided and Angiography-Guided Provisional Stenting of True Coronary Bifurcation Lesions The DKCRUSH-VI (Double Kissing Crush Versus Provisional Stenting Technique for Treatment of Coronary Bifurcation Lesions VI) Trial. Reference: Shao-Liang Chen et al. J Am Coll Cardiol Intv. 2015. Online before print.
Angiography for guiding the need to implant a stent in the side branch of a bifurcation after stent implantation in the main vessel has been successful for most injuries. Still standby a study about whether measurement of fractional flow reserve (FFR) could be superior to conventional angiography for guiding strategy of provisional stent.
The study included a total of 320 patients with bifurcation lesions (Medina 1, 1, 1 or 0, 1, 1) and a provisional stent strategy; randomized (1: 1) to angiography versus FFR to guide when stent implantation is necessary in the side branch. In the group guided by angiography a stent was implanted in the secondary vessel when after stent implantation in the main vessel TIMI flow <3, ostial lesion >70% or type A dissection. In the other group a stent was implanted in the side branch if after stent implantation in the main vessel measured of FFR was <0.8 in the accessory vessel. The primary end point was a composite of major adverse cardiac events (cardiac death, myocardial infarction and ischemia-driven TVR) at one year.
Treatment of secondary branch (balloon or stent) was performed in 63.1% of angiography group and 56.3% of the FFR group (p = 0.07) and a stent was implanted in 38.1% of group guided by angiography versus 25.9 % of FFR group (p = 0.01). When an attempt was made, we were able to successfully implant the stent in 83.6% of angiography group and 73.3% of the FFR group (p = 0.01). The combined of major cardiac events at one year, was identical in both groups (18.1% for both; p = 1). The rates of revascularization and stent thrombosis were 6.9% versus 5.6% (p = 0.82) and 1.3% versus 0.6% (p = 0.56) for the angiographic group and the FFR-guided group respectively.
Conclusion
In this multicenter, randomized trial, angiography and FFR were similar to guide the strategy of provisional stent in bifurcations.
Editorial comment
Again in bifurcations less is more and the strategy of provisional stent seems that it cannot be improved. Although the study included relatively few patients, the FFR did not even show a good turn tendency.
SOLACI