title: Clinical Outcome After DK Crush Versus Culotte Stenting of Distal Left Main Bifurcation Lesions: The 3-Year Follow-Up Results of the DKCRUSH-III Study.
abstract: OBJECTIVE
  The present study aimed to investigate the difference in major adverse cardiac events (MACE) at 3 years after double-kissing (DK) crush versus culotte stenting for unprotected left main distal bifurcation lesions (LMDBLs).
  
  
  BACKGROUND
  The multicenter and randomized DKCRUSH-III (Comparison of double kissing crush versus culotte stenting for unprotected distal left main bifurcation lesions: results from a multicenter, randomized, prospective study) showed that DK crush stenting was associated with fewer MACE at 1-year follow-up in patients with LMDBLs compared with culotte stenting. Here, we report the 3-year clinical outcome of the DKCRUSH-III study.
  
  
  METHODS
  A total of 419 patients with LMDBLs who were randomly assigned to either the DK crush or culotte group in the DKCRUSH-III study were followed for 3 year. The primary endpoint was the occurrence of a MACE at 3 years. Stent thrombosis (ST) was the safety endpoint. Patients were classified by simple and complex LMDBLs according to the DEFINITION (Definition and Impact of Complex Bifurcation Lesions on Clinical Outcomes After Percutaneous Coronary Intervention Using Drug-Eluting Stents) study criteria.
  
  
  RESULTS
  At 3 years, MACE occurred in 49 patients the culotte group and in 17 patients in the DK crush group (cumulative event rates of 23.7% and 8.2%, respectively; p < 0.001), mainly driven by increased myocardial infarction (8.2% vs. 3.4%, respectively; p = 0.037) and target-vessel revascularization (18.8% vs. 5.8%, respectively; p < 0.001) between groups. Definite ST rate was 3.4% in the culotte group and 0% in the DK crush group (p = 0.007). Complex LMDBLs were associated with a higher rate of MACE (35.3%) at 3 years compared with a rate of 8.1% in patients with simple LMDBLs (p < 0.001), with an extremely higher rate in the culotte group (51.5% vs. 15.1%, p < 0.001).
  
  
  CONCLUSIONS
  Culotte stenting for LMDBLs was associated with significantly increased rates of MACE and ST. (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-11001877).
authors: Nanjing First Hospital, Nanjing Medical University, Nanjing, China. Electronic address: chmengx@126.com.
authors: Shao-Liang
authors: SL
authors: Chen
authors: Beijing Fuwai Cardiovascular Hospital, Beijing, China.
authors: Bo
authors: B
authors: Xu
authors: Northen Hospital, Shenyang, China.
authors: Ya-Ling
authors: YL
authors: Han
authors: San Giovanni Battista Hospital, University of Turin, Turin, Italy.
authors: Imad
authors: I
authors: Sheiban
authors: Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
authors: Jun-Jie
authors: JJ
authors: Zhang
authors: Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
authors: Fei
authors: F
authors: Ye
authors: Beth Israel Hospital, New York, New York.
authors: Tak W
authors: TW
authors: Kwan
authors: Bangkok General Hospital, Bangkok, Thailand.
authors: Chitprapai
authors: C
authors: Paiboon
authors: Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors: Yu-Jie
authors: YJ
authors: Zhou
authors: Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors: Shu-Zheng
authors: SZ
authors: Lv
authors: Mount Sinai Hospital, New York, New York.
authors: George D
authors: GD
authors: Dangas
authors: Shanghai 10th Hospital, Shanghai, China.
authors: Ya-Wei
authors: YW
authors: Xu
authors: Daqing Oil General Hospital, Daqing, China.
authors: Shang-Yu
authors: SY
authors: Wen
authors: Jiangxi Provincial People's Hospital, Nanchang, China.
authors: Lang
authors: L
authors: Hong
authors: Shanghai Ruijin Hospital, Shanghai, China.
authors: Rui-Yan
authors: RY
authors: Zhang
authors: Xijing Hospital, Xi'an 4th Military Medical University, Xi'an, China.
authors: Hai-Chang
authors: HC
authors: Wang
authors: Tianjing Policemen Medical College Hospital, Tianjing, China.
authors: Tie-Ming
authors: TM
authors: Jiang
authors: Xia'Men Zhongshan Hospital, Xia'Men, China.
authors: Yan
authors: Y
authors: Wang
authors: Medistra Hospital, University of Indonesia Medical School, Jakarta, Indonesia.
authors: Teguh
authors: T
authors: Sansoto
authors: Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors: Fang
authors: F
authors: Chen
authors: Xi'an Communication University Hospital, Xi'an, China.
authors: Zu-Yi
authors: ZY
authors: Yuan
authors: Haarbin Medical University 1st Hospital, Haarbin, China.
authors: Wei-Min
authors: WM
authors: Li
authors: Cardiovascular Research Foundation, New York, New York.
authors: Martin B
authors: MB
authors: Leon
mesh_terms: D000368:Aged; D001208:Asia; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods* / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents; D013927:Thrombosis / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
keywords: culotte stenting; double-kissing crush; major adverse cardiac event(s); stent thrombosis; unprotected left main distal bifurcation lesions