Author + information
- Received February 20, 2019
- Revision received April 15, 2019
- Accepted April 23, 2019
- Published online October 7, 2019.
- Xiang Chen, MDa,∗,
- Xiaobo Li, MDa,∗,
- Jun-Jie Zhang, PhDa,∗,
- Yaling Han, MDb,
- Jing Kan, MBBSa,
- Lianglong Chen, MDc,
- Chunguang Qiu, MDd,
- Teguh Santoso, MDe,
- Chootopol Paiboon, MDf,
- Tak W. Kwan, MDg,
- Imad Sheiban, MDh,
- Martin B. Leon, MDi,
- Gregg W. Stone, MDi,∗∗ (, )@NanjingFirst,
- Shao-Liang Chen, MDa,j,∗ (, )
- for the DKCRUSH-V Investigators
- aDivision of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- bDivision of Cardiology, Shenyang Northen Hospital, Shenyang, China
- cDivision of Cardiology, United Hospital, Fujian Medical University, Fuzhou, China
- dDivision of Cardiology, Zhengzhou University First Hospital, Zhengzhou, China
- eDivision of Cardiology, Medistra Hospital, University of Indonesia Medical School, Jakarta, Indonesia
- fDivision of Cardiology, Bangkok General Hospital, Bangkok, Thailand
- gDivision of Cardiology, Beth Israel Hospital, New York, New York
- hDivision of Cardiology, Pederzoli Hospital-Peschiera del Garda, Verona, Italy
- iDivision of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
- jKey Laboratory of Cardiovascular and Cerebrovascular Medicine, School of Pharmacy, Nanjing Medical University, Nanjing, China
- ↵∗Address for correspondence:
Dr. Shao-Liang Chen, Division of Cardiology, Nanjing First Hospital, and College of Pharmacy, Nanjing Medical University, 68 Changle Road, Nanjing 210006, China.
- ↵∗∗Dr. Gregg W. Stone, Division of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, New York 10019.
Objectives The present study aimed to investigate the difference in target lesion failure (TLF) at 3 years after double kissing (DK) crush stenting versus provisional stenting (PS) for unprotected left main distal bifurcation (UPLMb) lesions.
Background The multicenter and randomized DKCRUSH-V (Double Kissing Crush versus Provisional Stenting for Left Main Distal Bifurcation Lesions: The DKCRUSH-V Randomized Trial) study showed fewer 1-year TLF after DK crush for UPLMb lesions compared with PS. The study reports the 3-year clinical outcome of the DKCRUSH-V study.
Methods A total of 482 patients with UPLMb lesions who were randomly assigned to either the DK crush group (DK group) or PS group in the DKCRUSH-V study were followed for 3 years. The primary endpoint was the occurrence of a TLF at 3 years. Stent thrombosis (ST) was the safety endpoint. Patients were classified by lesion’s complexity and NERS (New Risk Stratification) II or SYNTAX (Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery) score.
Results At 3 years, TLF occurred in 41 (16.9%) patients in the PS group and in 20 (8.3%) patients in the DK group (p = 0.005), mainly driven by increased target vessel myocardial infarction (5.8% vs. 1.7%; p = 0.017) and target lesion revascularization (10.3% vs. 5.0%; p = 0.029). Definite or probable ST rate at 3 years was 4.1% in the PS group and 0.4% in the DK group (p = 0.006). Notably, DK crush was associated with a significant reduction in both primary and secondary endpoints for patients with complex lesions or at high risk.
Conclusions Provisional stenting for UPLMb lesions was associated with significantly increased rates of TLF and ST over 3 years of follow-up. Further randomized study is warranted to confirm the benefits of DK crush stenting for complex UPLMb lesions. (Double Kissing and Double Crush versus Provisional T Stenting Technique for the Treatment of Unprotected Distal Left Main True Bifurcation Lesions: A Randomized, International, Multi-center Clinical Trial; ChiCTR-TRC-11001213).
↵∗ Drs. Chen, Li, and Zhang contributed equally to this work.
The DKCRUSH-V trial was funded by National Science Foundation of China grant numbers NSFC 91639303 and NSFC 81770441. Dr. Stone’s employer, Columbia University Medical Center, has received royalties from the sale of the MitraClip from Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 20, 2019.
- Revision received April 15, 2019.
- Accepted April 23, 2019.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.