ArticleAsiaIntervention2025
Double-kissing crush versus provisional stenting in patients with true coronary artery bifurcation lesions: a pooled individual patient-level analysis of randomised trials (DKCRUSH X trial).
Article in AsiaIntervention, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
13 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Provisional stenting is the standard treatment for patients with coronary artery bifurcation lesions. Aims: This pooled individual patient data (IPD) analysis aims to evaluate the long-term (six-year) outcomes of provisional stenting versus upfront two-stent techniques in patients with true coronary bifurcation lesions treated with drug-eluting stents. Methods: A systematic review and IPD analysis of randomised trials with centrally adjudicated endpoints was conducted to assess the efficacy and safety of provisional stenting versus upfront two-stent approaches in patients with true coronary bifurcation lesions undergoing percutaneous coronary intervention with drug-eluting stents. All patients were prospectively followed, with their intervention having been completed at least six years earlier. The primary endpoint, re-evaluated by an independent clinical event committee, was target lesion failure (TLF) - a composite of cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularisation - assessed at the final follow-up on 8 November 2024. Results: A total of 6,225 citations were screened, and four randomised trials met the inclusion criteria. Among 1,573 patients in the intention-to-treat population, TLF at six years occurred in 144 patients (Kaplan-Meier estimate 18.2%) in the upfront two-stent group and 193 (Kaplan-Meier estimate 24.7%) in the provisional stenting group (hazard ratio [HR] 0.71, 95% confidence interval [CI]: 0.57-0.89; p=0.0022, τ²=0.00, I Conclusions: This IPD analysis provides robust long-term evidence that upfront two-stent techniques, particularly double-kissing crush stenting, significantly reduce TLF over a six-year follow-up period compared with provisional stenting, especially in patients with complex bifurcations.
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