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DKCRUSH-III: Better outcomes with double-kissing crush than culotte stenting
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Double-kissing crush stenting was associated with improved 3-year outcomes compared with culotte stenting in a cohort of patients with unprotected left main distal bifurcation lesions, according to findings from the multicenter DKCRUSH-III study.
The researchers compared 3-year rates of MACE and stent thrombosis among patients randomly assigned to double-kissing (DK) crush stenting (n = 210) or culotte stenting (n = 209).
Cumulative MACE rates were 8.2% in the DK crush arm and a 23.7% rate in the culotte arm (P < .001). Increased rates of MI (3.4% vs. 8.2%; P = .037) and target vessel revascularization (5.8% vs. 18.8%; P < .001) in the culotte group drove this outcome, according to the researchers.
Patients with complex left main distal bifurcation lesions were more likely to experience MACE at 3 years than patients with simple lesions (35.3% vs. 8.1%; P < .001). Patients with complex lesions who were treated with culotte stenting were at an increased risk for MACE at 3 years (15.1% vs. 51.5%; P < .001).
No patients experienced definite stent thrombosis in the DK crush group, compared with 3.4% of patients in the culotte group (P = .007). Definite or probable stent thrombosis occurred in 1% of patients with simple lesions and 5% of those with complex lesions (P = .047). Among patients with complex lesions, definite or probable stent thrombosis occurred in 1.9% of patients treated with DK crush stenting and 7.6% of those treated with culotte stenting.
Leif Thuesen, MD, DMS, of the department of cardiology at Aalborg University Hospital, and Niels Ramsing Holm, MD, of the department of cardiology at Aarhus University Hospital, both in Denmark, wrote that the study was “high quality” and “well powered” in an accompanying editorial. They noted that 3-year event rates for this study were lower than those observed in the SYNTAX trial.
“A similar pattern was seen in DKCRUSH-I and -II, with very low event rates in the DK-crush groups as compared with other bifurcation stent technique studies,” they wrote. “This raises the question whether the DK-crush technique is better than the prevalent culotte and mini crush techniques and the provisional [side branch] treatment strategy in managing [left main coronary artery] and other coronary bifurcation lesions.”
They highlighted that the results were driven by lower rates of MI and TVR in the DK crush group. “It is unclear to what extent these events were related to the pre-scheduled 8-month angiographic control, but the event curves seem to start separating after 8 months,” they wrote. “Furthermore, it is unclear whether the [MIs] were procedure-related and specifically related to new target lesion revascularizations.”
Thuesen and Holm added that the positive results for DK crush stenting are “promising” for what they described as “an important lesion subset.”
“A randomized comparison of DK crush and [CABG] is probably wishful thinking, but it should be perfectly possible for other groups of investigators to confirm the results reported in DKCRUSH-III,” they concluded. – by Rob Volansky
Disclosure: The researchers report no relevant financial disclosures. Holm reports receiving institutional research grants from Abbott, Cordis, St. Jude Medical and Terumo and receiving speaking fees from St. Jude Medical and Terumo.
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