Three-Year Outcomes of the DKCRUSH-V Trial

October 17, 2019—The 3-year clinical outcomes of the DKCRUSH-V trial were published by Xiang Chen, MD, et al in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2019:12:1927–1937).

The multicenter randomized DKCRUSH-V study aimed to investigate the difference in target lesion failure (TLF) at 3 years after double-kissing (DK) crush stenting versus provisional stenting (PS) for unprotected left main distal bifurcation (UPLMb) lesions. Previously, the study showed a lower 1-year rate of TLF after DK crush for UPLMb lesions compared with PS.

The investigators concluded that the study showed PS for UPLMb lesions was associated with significantly increased rates of TLF and stent thrombosis over 3 years of follow-up.

As summarized in JACC: Cardiovascular Interventions, the DKCRUSH-V investigators randomly assigned 482 patients with UPLMb lesions to either the DK crush group (DK group) or PS group. The primary endpoint was the occurrence of a TLF at 3 years, and the safety endpoint was stent thrombosis. Patients were classified by lesion complexity and New Risk Stratification II or SYNTAX score.

At 3 years, the investigators reported the following for the PS group versus the DK group:

• TLF, 16.9% versus 8.3% (P = .005)
• Target vessel myocardial infarction, 5.8% versus 1.7% (P = .017)
• Target lesion revascularization, 10.3% versus 5% (P = .029)
• Definite or probable stent thrombosis rate, 4.1% versus 0.4% (P = .006)

DK crush was associated with a significant reduction in both primary and secondary endpoints for patients with complex lesions or at high risk. Further randomized study is warranted to confirm the benefits of DK crush stenting for complex UPLMb lesions, advised the investigators in JACC: Cardiovascular Interventions.