Work

Double-kissing crush versus provisional stenting in patients with true coronary artery bifurcation lesions: a pooled individual patient-level analysis of randomised trials (DKCRUSH X trial)

Year: 2025

Type: article

Abstract: BACKGROUND: Provisional stenting is the standard treatment for patients with coronary artery bifurcation lesions.AIMS: This pooled individual patient data (IPD) analysis aims to evaluate the long-term (six-year) outcomes of provisional stenting versus upfront two-stent techniques in patients with true coronary bifurcation lesions treated with drug-eluting stents.METHODS: A systematic review and IPD analysis of randomised trials with centrally adjudicated endpoints was conducted to assess the efficacy and safety of provisional stenting versus upfront two-stent approaches in patients with true coronary bifurcation lesions undergoing percutaneous coronary intervention with drug-eluting stents.All patients were prospectively followed, with their intervention having been completed at least six years earlier.The primary endpoint, re-evaluated by an independent clinical event committee, was target lesion failure (TLF) -a composite of cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularisationassessed at the final follow-up on 8 November 2024.RESULTS: A total of 6,225 citations were screened, and four randomised trials met the inclusion criteria.Among 1,573 patients in the intention-to-treat population, TLF at six years occurred in 144 patients (Kaplan-Meier estimate 18.2%) in the upfront two-stent group and 193 (Kaplan-Meier estimate 24.7%) in the provisional stenting group (hazard ratio [HR] 0.71, 95% confidence interval [CI]: 0.57-0.89;p=0.0022, τ²=0.00,I 2 =0%).These results were consistent across both unadjusted and per-protocol analyses.In patients with complex coronary bifurcation lesions, TLF occurred in 88 patients (Kaplan-Meier estimate 19.6%) in the two-stent group and 115 (Kaplan-Meier estimate 27.6%) in the provisional stenting group (HR 0.68, 95% CI: 0.52-0.90;p=0.0066).CONCLUSIONS: This IPD analysis provides robust long-term evidence that upfront two-stent techniques, particularly double-kissing crush stenting, significantly reduce TLF over a six-year follow-up period compared with provisional stenting, especially in patients with complex bifurcations.

Source: AsiaIntervention

DOI: 10.4244/aij-d-25-00021