Clinical Context

Intravascular ultrasound-guided percutaneous coronary intervention (PCI) has been associated with fewer clinical events compared with angiography-guided PCI. However, the benefit of double kissing (DK) crush remains uncertain.

This trial evaluated whether intravascular ultrasound (IVUS) guidance improves outcomes in this high-risk lesion subset.

Study Design

This multicenter, randomized, open-label trial was conducted at 24 centers in China.

Patients with clinical indications for PCI and complex bifurcation lesions defined by DEFINITION criteria were randomized in a 1:1 ratio to IVUS-guided PCI or angiography-guided PCI. The definition of complexity particularly included side-branch lesion length ≥10 mm.

A total of 555 patients were enrolled, with 277 assigned to IVUS-guided PCI and 278 to angiography-guided PCI.

The DK crush technique was used in 96.8% of patients. The primary endpoint was target vessel failure at 1 year, defined as a composite of cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularization.

Key Findings 

At 1 year, the primary endpoint occurred in 17 patients (6.1%) in the IVUS-guided PCI group and in 41 patients (14.7%) in the angiography-guided PCI group.

This corresponded to a hazard ratio of 0.40 (95% confidence interval: 0.23–0.71; P = 0.002), indicating a significant reduction in target vessel failure with IVUS-guided PCI.

The treatment effect was driven mainly by reductions in target vessel myocardial infarction and clinically driven target vessel revascularization.

A total of 124 patients (44.8%) in the IVUS-guided group and 122 patients (43.9%) in the angiography-guided group had left main coronary artery bifurcation involvement.

Clinical Perspective

In patients with complex coronary bifurcation lesions treated with the DK crush technique, IVUS-guided PCI reduced target vessel failure at 1 year compared with angiography guidance.

The findings indicate that the benefit of IVUS guidance was largely associated with achieving IVUS-defined procedural optimization targets rather than IVUS use alone.

Key Takeaway

IVUS-guided PCI reduced 1-year target vessel failure compared with angiography-guided PCI in complex bifurcation lesions treated with DK crush.

Author

Manjusha Shetty is Senior Editor at MedApt, a physician-focused platform covering clinical updates, congress insights, and expert perspectives.