DKCRUSH-V: What Is Simple Is Not Always Best for the Left Main Coronary Artery

Courtesy of the SBHCI.

Angioplasty of true distal left main bifurcation lesions with a double-kissing (DK) crush two-stent strategy, compared with provisional stenting, results in lower rates of target lesion failure at 1 year.

These findings were largely driven by lower rates of target vessel infarction and definite/probable stent thrombosis.

Read also: “EXCEL-QOL Substudy: Similar Quality of Life both with CABG and Left Main PCI”.

This work, published simultaneously in the Journal of the American College of Cardiology and presented by lead investigator Dr. Shao-Liang Chen, is the first one to randomize patients with left main bifurcation lesions to the DK crush technique vs. provisional stenting.

The DK crush strategy had already resulted superior to the culotte stenting technique, but it had not been compared to provisional stenting, the preferred treatment for bifurcation lesions.

The DKCRUSH-V trial randomized 482 patients with left main bifurcation lesions (72.2% with unstable angina; mean Syntax score 30.6) to either provisional (n = 242) or DK crush stenting (n = 240) at 26 centers in China, Indonesia, Thailand, Italy, and the United States.

Read also: “CULPRIT-SHOCK Results Will Transform Guidelines and Clinical Practice”.

At 1 year, the rate for the primary endpoint (a composite of cardiac death, target-vessel infarction, or clinically driven revascularization) was lower for patients in the DK-crush group than for those treated with provisional stenting (5.0% vs. 10.7%; hazard ratio [HR]: 0.42; 95% confidence interval [CI]: 0.21-0.85). The two-stent strategy also resulted in lower rates of target-vessel infarction (0.4% vs. 2.9%; p = 0.03) and definite/probable stent thrombosis (0.4% vs. 3.3%; p = 0.02).

In order to qualify for this study, operators needed to have performed at least 300 angioplasties, including procedures on left main coronary artery lesions, per year for at least 5 years.

These numbers are far from reality for most operators: for example, in the United States, 44% of all operators perform less than 50 angioplasties per year.

Courtesy of the Brazilian Society of Hemodynamics and Interventional Cardiology (SBHCI).

Original title: Double Kissing Crush Versus Provisional Stenting for Left Main Distal Bifurcation Lesions: DKCRUSH-V Randomized Trial.

Presenter: Chen S-L.

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.