Double-Kissing Crush Versus Provisional Stenting for Coronary Bifurcations: A 1-Year Follow-up Study in Vietnam

Abstract

Background

Coronary bifurcation lesions (CBLs) present significant challenges in interventional cardiology, especially in low and middle-income countries like Vietnam. While the double-kissing (DK) crush technique is gaining attention for its potential benefits, its efficacy and safety compared with provisional stenting (PS) in the Vietnamese population remain underexplored. This study aimed to assess the effectiveness of the DK crush technique in reducing major adverse cardiovascular events (MACE) compared with those of PS, providing essential data to inform clinical decision-making in settings with limited resources.

Methods

This prospective cohort study included 58 patients with CBL, 33 patients undergoing the DK crush technique and 25 receiving PS. Clinical follow-up at 1, 3, 9, and 12 months assessed MACE, including cardiovascular disease–related death, acute myocardial infarction, hospitalization for heart failure, and stroke.

Results

Post-percutaneous coronary intervention side branch diameter stenosis in the DK crush group was 5.64% ± 5.80%, significantly lower than the PS group (48.2% ± 28.5%; P < .001). One-year follow-up data revealed greater MACE reduction in the DK crush group (91% MACE-free vs 72% in the PS group; P = .03; hazard ratio [HR], 3.689; 95% CI, 1.034-13.160). However, the DK crush technique had longer procedural times (91.1 vs 54.6 minutes) and required higher contrast and radiation doses (P < .01).

Conclusions

Although DK crush requires longer procedure times and greater radiation exposure, it results in greater MACE reduction than does PS in patients with CBL. Clinicians should weigh the benefits and limitations of both techniques, particularly in resource-limited settings.