Author + information
- Received April 3, 2015
- Revision received May 6, 2015
- Accepted May 22, 2015
- Published online August 24, 2015.
- Shao-Liang Chen, MD∗∗ (, )
- Bo Xu, MBBS†,
- Ya-Ling Han, MD‡,
- Imad Sheiban, MD§,
- Jun-Jie Zhang, MD∗,
- Fei Ye, MD∗,
- Tak W. Kwan, MD‖,
- Chitprapai Paiboon, MD¶,
- Yu-Jie Zhou, MD#,
- Shu-Zheng Lv, MD#,
- George D. Dangas, MD∗∗,
- Ya-Wei Xu, MD††,
- Shang-Yu Wen, MD‡‡,
- Lang Hong, MD§§,
- Rui-Yan Zhang, MD‖‖,
- Hai-Chang Wang, MD¶¶,
- Tie-Ming Jiang, MD##,
- Yan Wang, MD∗∗∗,
- Teguh Sansoto, MD†††,
- Fang Chen, MD#,
- Zu-Yi Yuan, MD‡‡‡,
- Wei-Min Li, MD§§§ and
- Martin B. Leon, MD‖‖‖
- ∗Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- †Beijing Fuwai Cardiovascular Hospital, Beijing, China
- ‡Northen Hospital, Shenyang, China
- §San Giovanni Battista Hospital, University of Turin, Turin, Italy
- ‖Beth Israel Hospital, New York, New York
- ¶Bangkok General Hospital, Bangkok, Thailand
- #Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- ∗∗Mount Sinai Hospital, New York, New York
- ††Shanghai 10th Hospital, Shanghai, China
- ‡‡Daqing Oil General Hospital, Daqing, China
- §§Jiangxi Provincial People’s Hospital, Nanchang, China
- ‖‖Shanghai Ruijin Hospital, Shanghai, China
- ¶¶Xijing Hospital, Xi’an 4th Military Medical University, Xi’an, China
- ##Tianjing Policemen Medical College Hospital, Tianjing, China
- ∗∗∗Xia’Men Zhongshan Hospital, Xia’Men, China
- †††Medistra Hospital, University of Indonesia Medical School, Jakarta, Indonesia
- ‡‡‡Xi’an Communication University Hospital, Xi’an, China
- §§§Haarbin Medical University 1st Hospital, Haarbin, China
- ‖‖‖Cardiovascular Research Foundation, New York, New York
- ↵∗Reprint requests and correspondence:
Dr. Shao-Liang Chen, Cardiological Department, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, China.
Objectives The present study aimed to investigate the difference in major adverse cardiac events (MACE) at 3 years after double-kissing (DK) crush versus culotte stenting for unprotected left main distal bifurcation lesions (LMDBLs).
Background The multicenter and randomized DKCRUSH-III (Comparison of double kissing crush versus culotte stenting for unprotected distal left main bifurcation lesions: results from a multicenter, randomized, prospective study) showed that DK crush stenting was associated with fewer MACE at 1-year follow-up in patients with LMDBLs compared with culotte stenting. Here, we report the 3-year clinical outcome of the DKCRUSH-III study.
Methods A total of 419 patients with LMDBLs who were randomly assigned to either the DK crush or culotte group in the DKCRUSH-III study were followed for 3 year. The primary endpoint was the occurrence of a MACE at 3 years. Stent thrombosis (ST) was the safety endpoint. Patients were classified by simple and complex LMDBLs according to the DEFINITION (Definition and Impact of Complex Bifurcation Lesions on Clinical Outcomes After Percutaneous Coronary Intervention Using Drug-Eluting Stents) study criteria.
Results At 3 years, MACE occurred in 49 patients the culotte group and in 17 patients in the DK crush group (cumulative event rates of 23.7% and 8.2%, respectively; p < 0.001), mainly driven by increased myocardial infarction (8.2% vs. 3.4%, respectively; p = 0.037) and target-vessel revascularization (18.8% vs. 5.8%, respectively; p < 0.001) between groups. Definite ST rate was 3.4% in the culotte group and 0% in the DK crush group (p = 0.007). Complex LMDBLs were associated with a higher rate of MACE (35.3%) at 3 years compared with a rate of 8.1% in patients with simple LMDBLs (p < 0.001), with an extremely higher rate in the culotte group (51.5% vs. 15.1%, p < 0.001).
Conclusions Culotte stenting for LMDBLs was associated with significantly increased rates of MACE and ST. (Double Kissing [DK] Crush Versus Culotte Stenting for the Treatment of Unprotected Distal Left Main Bifurcation Lesions: DKCRUSH-III, a Multicenter Randomized Study Comparing Double-Stent Techniques; ChiCTR-TRC-11001877)
- culotte stenting
- double-kissing crush
- major adverse cardiac event(s)
- stent thrombosis
- unprotected left main distal bifurcation lesions
This study was funded by the Jiangsu Provincial Outstanding Medical Program (JPOMP-20071230). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 3, 2015.
- Revision received May 6, 2015.
- Accepted May 22, 2015.
- 2015 American College of Cardiology Foundation