Double Kissing Crush Versus Culotte for Bifurcation Percutaneous Coronary Interventions: Insights From the PROGRESS-BIFURCATION Registry

Upfront 2-stent techniques are often used in bifurcation percutaneous coronary interventions (PCI), but there is controversy about optimal strategy selection. The authors examined the clinical and angiographic characteristics and long-term outcomes of 232 bifurcation PCIs that were performed using the double kissing (DK) crush or culotte technique in 216 patients between 2014 and 2023 using data from the Prospective Global Registry for the Study of Bifurcation Lesion Interventions (NCT05100992). The inverse probability of treatment weighted (IPTW) Cox proportional hazards model was used to assess long-term outcomes. DK crush was more commonly used (69.0%). Patients in the DK-crush group had similar baseline characteristics to those in the culotte group. Lesions treated with DK crush were more likely to be in the left main coronary artery (42.9% vs 15.5%, P less than .001), had larger proximal (3.50 [3.50-4.00] vs 3.50 [3.21-3.79] mm, P = .027) and distal (3.00 [3.00-3.50] vs 3.00 [2.75-3.25] mm, P = .047) main vessel diameter, and were more likely to have severe calcification (29.8% vs 5.6%, P less than .001). Technical (98.8% vs 97.2%, P = .588), procedural success (96.5% vs 95.1%, P = .698), and in-hospital major adverse cardiovascular events (MACE) (6.1% vs 3.0%, P = .509) were similar in both groups. During a median follow-up of 43 months, 60 (33.9%) patients experienced MACE. On IPTW adjusted Cox analysis, DK crush was associated with lower follow-up MACE (hazard ratio 0.28; 95% CI, 0.13-0.60; P = .001) compared with culotte driven by lower target vessel revascularization (TVR) (14.3% vs 29.3%, P = .029). Compared with culotte, DK crush is associated with similar periprocedural outcomes but lower TVR and MACE during follow-up.