Comparison of long‐term outcomes of double kissing crush versus T and minimal protrusion techniques in complex bifurcation lesions: The EVOLUTE‐CRUSH II registry

Author:

Uzun Fatih1,Güner Ahmet1ORCID,Demirci Gökhan1ORCID,Çiloğlu Koray1,Uysal Hande1,Çizgici Ahmet Yaşar1,Bulut Ümit1,Kahraman Serkan1ORCID,Ağuş Hicaz Zencirkıran1,Gökçe Kaan1,Doğan Abdullah1ORCID,Akman Cemalettin1ORCID,Yalçın Ahmet Arif1,Aktürk İbrahim Faruk1,Köseoğlu Mehmet2,Kalkan Ali Kemal1,Ertürk Mehmet1,Karagöz Ali3ORCID,Colombo Antonio45

Affiliation:

1. Department of Cardiology, University of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul Turkey

2. Department of Anesthesia, University of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul Turkey

3. Department of Cardiology, University of Health Sciences Koşuyolu Kartal Heart Training and Research Hospital Istanbul Turkey

4. Department of Biomedical Sciences Humanitas University Pieve Emanuele‐Milan Italy

5. Humanitas Clinical and Research Center IRCCS Rozzano‐Milan Italy

Abstract

AbstractBackgroundDouble kissing (DK)‐crush and T‐stenting and small protrusion (TAP) techniques are gaining popularity, but the comparison for both techniques is still lacking. This study sought to retrospectively evaluate the long‐term outcomes of DK‐crush and TAP techniques in patients with complex bifurcation lesions.MethodsA total of 255 (male: 205 [80.3%], mean age: 59.56 ± 10.13 years) patients who underwent coronary bifurcation intervention at a single‐center between January 2014 and May 2021 were included. Angiographic features, procedure details, and in‐hospital or long‐term outcomes were assessed. The primary endpoint was target lesion failure (TLF), defined as the combination of cardiac death, target vessel myocardial infarction, or clinically driven‐target lesion revascularization (TLR). The regression models were adjusted applying by the inverse probability weighted (IPW) approach to reduce treatment selection bias.ResultsThe initial management strategy was DK‐crush in 152 (59.6%) patients and TAP in 103 (40.4%) cases. The SYNTAX scores (24.58 ± 7.4 vs. 24.26 ± 6.39, p = 0.846) were similar in both groups. The number of balloon (6.32 ± 1.82 vs. 3.92 ± 1.19, p < 0.001) usage was significantly higher in the DK‐crush group than in the TAP group. The rates of TLF (11.8 vs. 22.3%, p = 0.025) and clinically driven TLR (6.6 vs. 15.5%, p = 0.020) were significantly lower in the DK‐crush group compared to the TAP group. The long‐term TLF was significantly higher in the TAP group compared to the DK‐crush group (unadjusted HR: 1.974, [95% CI: 1.044–3.732], p = 0.035 and adjusted HR [IPW]: 2.498 [95% CI: 1.232–5.061], p = 0.011).ConclusionThe present study showed that the DK‐crush technique of bifurcation treatment was associated with lower long‐term TLF and TLR rates compared to the TAP technique.

Publisher

Wiley

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