DK‐Crush or Mini‐Crush Stenting for Complex Left Main Bifurcation Lesions: The Multicenter EVOLUTE‐CRUSH LM Registry
Fatih Uzun, Ahmet Güner, Aykun Hakgör, Elnur Alızade, Mehmet Baran Karataş, Gökhan Alıcı, Ahmet Yaşar Çizgici, İrfan Şahin, İlker Gül, Hamdi Püşüroğlu, Ahmet Karaduman, Cemalettin Akman, Ali Ataş, Muhammed Furkan Deni̇z, Deniz Dilan Naki Tekin, Ebru Serin, Mehmet Kocaağa, Mustafa Yaşan, İlhan İlker Avcı, Oktay Şenöz, Perihan Varım, Abdullah Doğan, Atakan Dursun, Tuba Unkun, İlyas Çetin, Murat Gökalp, Veysel Ozan Tanık, İbrahim F. Aktük, Beytullah Çakal, Kudret Keskin, Ezgi Gültekin Güner, Aybüke Şimşek, Muhammet Ali Ekiz, Seda Tanyeri Üzel, Çağdaş Buluş, Koray Çiloğlu, Muhammed Mert Göksu, Ali Nazmi Çalık, Bilal Boztosun
Abstract
Background The comparison of outcomes of mini‐crush (MCT) versus double kissing crush (DKC) techniques for complex left main bifurcation (LMB) lesions is still lacking. This investigation aimed to assess the long‐term outcomes of patients who underwent MCT or DKC for LMB disease. Methods From 2014 to 2024, patients who underwent percutaneous coronary intervention for complex LMB lesions were retrospectively collected. The primary end point was major adverse cardiac events as the combination of cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization during follow‐up. The secondary end point was measured as major adverse cardiovascular and cerebral events including all‐cause death, target vessel revascularization, target vessel myocardial infarction, stent thrombosis, and stroke. Results This large‐scale multicenter (n=13) observational study included a total of 531 consecutive patients (men: 405 [76.3%], mean age: 63.16±11.26 years) with complex LMB lesions who underwent percutaneous coronary intervention. The initial revascularization strategy was MCT in 313 (59%) patients and DKC in 218 (41%) patients. The number of balloons used (5.91±1.53 versus 6.72±1.70, P <0.001) and procedure time (66.60±24.20 versus 72.97±19.97 minutes, P <0.001) were notably lower in the MCT group. In the overall population, the long‐term major adverse cardiac events (hazard ratio [HR], 0.704; P =0.169) and major adverse cardiovascular and cerebral events (HR, 0.660; P =0.079) did not differ in individuals with complex LMB lesions treated with MCT and DKC. Other end points were also comparable between the 2 groups. Conclusions In complex LMB lesions, risk‐adjusted major adverse cardiac events and major adverse cardiovascular and cerebral events rates were comparable between both techniques, with a nonsignificant trend favoring DKC at long‐term follow‐up. Registration URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT06546748.