Bifurcations: A Long Return Journey

When it looked like the simplest techniques reach the best outcomes, along came the DK Crush studies. Indeed, after the COVIS III results in bifurcations, it appeared we had started to retrace our steps back to the foundation. 

DKCRUSH-V: El tronco de la coronaria izquierda no es una bifurcación más

The purpose of this study was to compare long term outcomes of the remarkably simple 1-stent strategy to the main vessel (MV) with simple crossover alone vs. an additional side branch (SB) opening procedure with a second guidewire finalized with a kissing balloon.

Patients undergoing coronary PCI to a bifurcation (including left main) with the single stent strategy were included in this registry. 

2,194 patients were divided into the simple crossover–alone group (n=1.685, 76.8%) and the SB-opening group (n=509, 23.2%). Target lesion failure rate (a composite of cardiac death, target vessel myocardial infarction, and target lesion repeat revascularization) was assessed at a 5-year followup. 

The angiographic characteristics of patients in the SB-opening group with kissing balloon were more severe, even though lumen diameter resulted larger in this group. 

After 5 years, target lesion failure rate was similar between groups (7% vs 6.7%; p=0.947). 


Read also: A Headache for Cardiologists: Ischemia with Non-Obstructive Disease.


This was also true for the subgroup with left main lesion (9.5% vs. 11.3%; p=0.442) and lesions classified as Medina 1.1.1, 1.0.1 and 0.1.1 (5.3% vs. 7.8%; p=0.362). The latter are normally called true bifurcations. 

Conclusion

The remarkably simple 1-stent strategy to the main vessel with simple crossover alone showed long term comparable results to those obtained with an additional side branch opening procedure with a second guidewire finalized with a kissing balloon. 

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Original title: 5-Year Outcome of Simple Crossover Stenting in Coronary Bifurcation Lesions Compared With Side Branch Opening. COBIS III 

Reference: Cheol Hyun Lee et al. JACC: Asia 2021;1:53–64.https://doi.org/10.1016/j.jacasi.2021.04.002


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