5-Year Outcomes of Comparing Double Kissing-Mini-culotte with Mini-culotte using Drug-eluting Stents for The Treatment of True Coronary Bifurcation Lesions

Abstract

Abstract Aims To compare the clinical outcomes between Double Kissing Mini-culotte stenting (DKMC) and Mini-culotte (MC) stenting in treating patients with true coronary bifurcation lesions (CBLs) in the clinical real world. Methods This retrospective observational cohort study included 180 consecutive patients with true CBLs (Medina type 1,1,1; 1,0,1; 0,1,1). All the eligible patients underwent coronary angiography and percutaneous coronary intervention (PCI) with two-stent techniques in our hospital, among whom 97 received DKMC treatment (DKMC group) and 83 MC treatment. The primary clinical endpoints were the major adverse cardiovascular events (MACE), which included cardiac death, myocardial infarction, and target vessel/ lesion revascularization (TVR/TLR). The secondary endpoints were stent thrombosis, in-stent restenosis, and individual components of MACE. Results Quantitative coronary angiography analysis (at 1 year) showed that late lumen loss (0.12 ± 0.42mm vs. 0.22 ± 0.39mm, P = 0.045), segmental diameter restenosis of side branch (17.56 ± 10.23% vs. 23.62 ± 13.28%, P = 0.032) in the DKMC stenting group were lower as compared with MC group. There were similar rates of binary restenosis in the main parent vessel (1.2% vs. 2.9%) and the main branch (4.8% vs. 5.9% in both groups with a numerically lower rate of binary restenosis in the side branch in DKMC (6.2% vs. 13.2%, P = 0.141) irrespective of lack of significant differences. However, compared to MC stenting group, the cumulative event rate of MACE at 5 years (22.8% vs.8.3%, P = 0.007) and TVR/TLR (17.7% vs.6.3%, P = 0.018) in the DKMC stenting group was mainly caused by TVR/TLR. Especially, DKMC was related to a significant reduction in the primary and secondary endpoints in patients with high risk. Conclusion DKMC stenting is associated with lower late lumen loss and restenosis in the side branch, a lower rate of cumulative MACE, and TVR/TLR, and is more effective in treating true CBLs compared to MC stenting; yet, this needs to be further confirmed by a randomized clinical trial.