A Randomized Clinical Study Comparing Double Kissing Crush With Provisional Stenting for Treatment of Coronary Bifurcation Lesions

Chen, Shao‐Liang; Santoso, Teguh; Zhang, Junjie; Ye, Fei; Xu, Yawei; Fu, Qiang; Kan, Jing; Paiboon, Chitprapai; Yong, Zhou; Ding, Shi-Qing; Kwan, Tak

doi:10.1016/j.jacc.2010.10.023

Cited by 245 publications

(76 citation statements)

References 23 publications

(20 reference statements)

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“…The DKCRUSH II trial did not show a difference in MACE between provisional stenting and crush stenting, but did show a significantly higher rate of TVR in the provisional group ( p = 0.017) [18]. In our study, we did not find a significant difference in MACE between provisional (one-stent technique) and non-provisional stenting (two-stent techniques).…”

Section: Discussion and Limitationscontrasting

confidence: 66%

Evaluation of bifurcation stenting techniques at Catharina Hospital, Eindhoven in 2013

et al. 2016

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AimsPercutaneous coronary intervention (PCI) of bifurcation lesions can be performed using various techniques. The aim of this study was to analyse the outcome of various techniques of bifurcation stenting in all patients undergoing bifurcation stenting at one large intervention centre in 2013, taking into account that more complex lesions might more often warrant a two-stent technique.Methods and resultsThis retrospective study included 260 consecutive patients who underwent non-primary PCI of a bifurcation lesion at the Catharina Hospital, Eindhoven, in 2013. Patients were classified into two groups: one-stent technique (provisional stenting), and two-stent techniques (culotte, crush and T‑stenting). The primary endpoint was the rate of restenosis at 1 year. The secondary endpoints were procedural complications (side branch occlusion, periprocedural infarction, and death) and major adverse cardiac events (MACE) at 1 year. Periprocedural complications occurred in 15 patients (5.8 %) with no difference between the groups (p = 0.27). After 1 year, restenosis occurred in 3.2 % of the patients in the one-stent technique group and 7.3 % in the two-stent technique group (p = 0.20). MACE at 1 year did not differ between the groups at 11.9 % and 12.2 % respectively (p = 1.00).ConclusionsThis study shows that there is no significant difference between restenosis rate, or any other outcome parameter, with the different techniques of bifurcation stenting. Since provisional stenting is the simplest, most straightforward and cheapest approach, if technically feasible this technique has our preference as the initial approach, and an upgrade can be considered if the result is insufficient.

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Section: Discussion and Limitationscontrasting

confidence: 66%

Evaluation of bifurcation stenting techniques at Catharina Hospital, Eindhoven in 2013

et al. 2016

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“…Since the “double kissing crush (DK Crush) with two stents” technique for bifurcation lesions was first reported by Chen et al (34), the improved clinical outcomes had been observed mainly appeared as significant reduction in TLR and TVR risks. It should be noted that thrombosis might be thought as possible reason leading to repeat revascularization.…”

Section: Discussionmentioning

confidence: 99%

The outcomes of intravascular ultrasound-guided drug-eluting stent implantation among patients with complex coronary lesions: a comprehensive meta-analysis of 15 clinical trials and 8,084 patients

Fan

Gao²,

Li³

et al. 2017

Anatol J Cardiol

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Objective:The effects of intravascular ultrasound (IVUS)-guided drug-eluting stent (DES) implantation in patients with complex coronary artery lesions remains to be controversial. This study sought to evaluate the outcomes of IVUS guidance in these patients.Methods:The EMBASE, Medline, and other internet sources were searched for relevant articles. The primary endpoint was major adverse cardiac events (MACE), including all-cause mortality, myocardial infarction (MI), and target-vessel revascularization (TVR). The incidence of definite/probable stent thrombosis (ST) was analyzed as the safety endpoint.Results:Fifteen clinical trials involving 8.084 patients were analyzed. MACE risk was significantly decreased following IVUS-guided DES implantation compared with coronary angiography (CAG) guidance (odds ratio [OR] 0.63, 95% confidence intervals [CI]: 0.53–0.73, p<0.001), which might mainly result from the lower all-cause mortality risk (OR 0.52, 95% CI: 0.40–0.67, p<0.001), MI (OR 0.70, 95% CI: 0.56–0.86, p=0.001), and TVR (OR 0.53, 95% CI: 0.40–0.70, p<0.001). The subgroup analyses indicated better outcomes of IVUS guidance in DES implantation for these patients with left main disease or bifurcation lesions.Conclusion:IVUS guidance in DES implantation is associated with a significant reduction in MACE risk in patients with complex lesions, particularly those with left main disease or bifurcation lesions. More large and powerful randomized trials are still warranted to guide stenting decision making. (Anatol J Cardiol 2017; 17: 258-68)

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“…MI was diagnosed if increased plasma CK-MB levels doubled its baseline value immediately before stenting in acute MI patients or new abnormal Q-wave was detected with ECG. TVR, TLR, and CABG were defined according to the Academic Research Consortium (ARC) definitions [22], and Double Kissing Crush criteria [23], respectively. ST was defined as the occurrence of ACS with angiographic confirmation of thrombosis according to the ARC criteria [24].…”

Section: Methodsmentioning

confidence: 99%

Increased Risk for Developing Major Adverse Cardiovascular Events in Stented Chinese Patients Treated with Dual Antiplatelet Therapy after Concomitant Use of the Proton Pump Inhibitor

et al. 2014

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BackgroundSome clinical studies have demonstrated that the proton pump inhibitor (PPI) could decrease clopidogrel platelet response and increase major adverse cardiovascular events (MACE) in white or black subjects. However, that remains to be determined in Chinese patients. In this study, we sought to determine whether there could be an increased risk for developing MACE after concomitant use of dual antiplatelet therapy (DAT) and a PPI in Chinese patients treated with percutaneous coronary intervention (PCI) and stenting.MethodsThis study was a 5-year, single-center, retrospective cohort analysis of eligible patients (n = 6188) who received DAT and a PPI concomitantly (defined as PPI users) before discharge and/or 12-month follow-up after discharge as compared with those who received DAT alone (also defined as non-PPI users, n = 1465). The incidence of recurrent MACE, such as myocardial infarction (MI), definite stent thromboses (ST), or cardiovascular death, was compared between the PPI users and non-users.ResultsPPI users had a significantly higher incidence of the MACE than non-users (13.9% vs. 10.6%; adjusted HR: 1.33; 95% CI: 1.12 – 1.57, P = 0.007). Stratified analysis revealed that concurrent use of DAT and a PPI was associated with a significantly increased risk for developing ST compared with DAT alone (1% vs. 0.4%; adjusted HR: 2.66, 95% CI: 1.16 – 5.87, P = 0.012). However, there were no significant differences in the risk of MI, cardiovascular death and other adverse events, regardless of combination of clopidogrel and a PPI.ConclusionsThe study further suggests that concomitant use of DAT and a PPI may be associated with an increased risk for developing MACE, in particular definite ST, in Chinese PCI patients after discharge as compared with use of DAT alone.

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A Randomized Clinical Study Comparing Double Kissing Crush With Provisional Stenting for Treatment of Coronary Bifurcation Lesions

Cited by 245 publications

References 23 publications

Evaluation of bifurcation stenting techniques at Catharina Hospital, Eindhoven in 2013

Evaluation of bifurcation stenting techniques at Catharina Hospital, Eindhoven in 2013

The outcomes of intravascular ultrasound-guided drug-eluting stent implantation among patients with complex coronary lesions: a comprehensive meta-analysis of 15 clinical trials and 8,084 patients

Increased Risk for Developing Major Adverse Cardiovascular Events in Stented Chinese Patients Treated with Dual Antiplatelet Therapy after Concomitant Use of the Proton Pump Inhibitor

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