• Shao-Liang Chen, Bo Xu, Ya-Ling Han, Imad Sheiban, Jun-Jie Zhang, Fei Ye, Tak W Kwan, Chitprapai Paiboon, Yu-Jie Zhou, Shu-Zheng Lv, George D Dangas, Ya-Wei Xu, Shang-Yu Wen, Lang Hong, Rui-Yan Zhang, Hai-Chang Wang, Tie-Ming Jiang, Yan Wang, Fang Chen, Zu-Yi Yuan, Wei-Min Li, and Martin B Leon.
• Cardiological Department, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
• J. Am. Coll. Cardiol. 2013 Apr 9; 61 (14): 1482-8.

ObjectivesThe study aimed to investigate the difference in major adverse cardiac event (MACE) at 1-year after double kissing (DK) crush versus Culotte stenting for unprotected left main coronary artery (UPLMCA) distal bifurcation lesions.BackgroundDK crush and Culotte stenting were reported to be effective for treatment of coronary bifurcation lesions. However, their comparative performance in UPLMCA bifurcation lesions is not known.MethodsA total of 419 patients with UPLMCA bifurcation lesions were randomly assigned to DK (n = 210) or Culotte (n = 209) treatment. The primary endpoint was the occurrence of a MACE at 1 year, including cardiac death, myocardial infarction, and target vessel revascularization (TVR). In-stent restenosis (ISR) at 8 months was secondary endpoint, and stent thrombosis (ST) served as a safety endpoint. Patients were stratified by SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) and NERS (New Risk Stratification) scores.ResultsPatients in the Culotte group had significant higher 1-year MACE rate (16.3%), mainly driven by increased TVR (11.0%), compared with the DK group (6.2% and 4.3%, respectively; all p < 0.05). ISR rate in side branch was 12.6% in the Culotte group and 6.8% in the DK group (p = 0.037). Definite ST rate was 1.0% in the Culotte group and 0% in the DK group (p = 0.248). Among patients with bifurcation angle ≥70°, NERS score ≥20, and SYNTAX score ≥23, the 1-year MACE rate in the DK group (3.8%, 9.2%, and 7.1%, respectively) was significantly different to those in the Culotte group(16.5%, 20.4%, and 18.9%, respectively; all p < 0.05).ConclusionsCulotte stenting for UPLMCA bifurcation lesions was associated with significantly increased MACEs, mainly due to the increased TVR. (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-00000151).Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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