title: Comparison of double kissing crush versus Culotte stenting for unprotected distal left main bifurcation lesions: results from a multicenter, randomized, prospective DKCRUSH-III study.
abstract: OBJECTIVE
  The 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.
  
  
  BACKGROUND
  DK 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.
  
  
  METHODS
  A 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.
  
  
  RESULTS
  Patients 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).
  
  
  CONCLUSIONS
  Culotte 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).
authors.affiliation: Cardiological Department, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
authors.forename: Shao-Liang
authors.initials: SL
authors.lastname: Chen
authors.forename: Bo
authors.initials: B
authors.lastname: Xu
authors.forename: Ya-Ling
authors.initials: YL
authors.lastname: Han
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
authors.forename: Jun-Jie
authors.initials: JJ
authors.lastname: Zhang
authors.forename: Fei
authors.initials: F
authors.lastname: Ye
authors.forename: Tak W
authors.initials: TW
authors.lastname: Kwan
authors.forename: Chitprapai
authors.initials: C
authors.lastname: Paiboon
authors.forename: Yu-Jie
authors.initials: YJ
authors.lastname: Zhou
authors.forename: Shu-Zheng
authors.initials: SZ
authors.lastname: Lv
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
authors.forename: Ya-Wei
authors.initials: YW
authors.lastname: Xu
authors.forename: Shang-Yu
authors.initials: SY
authors.lastname: Wen
authors.forename: Lang
authors.initials: L
authors.lastname: Hong
authors.forename: Rui-Yan
authors.initials: RY
authors.lastname: Zhang
authors.forename: Hai-Chang
authors.initials: HC
authors.lastname: Wang
authors.forename: Tie-Ming
authors.initials: TM
authors.lastname: Jiang
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.forename: Fang
authors.initials: F
authors.lastname: Chen
authors.forename: Zu-Yi
authors.initials: ZY
authors.lastname: Yuan
authors.forename: Wei-Min
authors.initials: WM
authors.lastname: Li
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods*; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000379:methods; D023903:Coronary Restenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome