Uzun Fatih, Güner Ahmet, Hakgör Aykun, Alizade Elnur, Karataş Mehmet B, Alıcı Gökhan, Çizgici Ahmet Y, Şahin İrfan, Gül İlker, Püşüroğlu Hamdi, Karaduman Ahmet, Akman Cemalettin, Ataş Ali E, Deniz Muhammed F, Tekin Deniz N, Serin Ebru, Kocaağa Mehmet, Yaşan Mustafa, Avcı İlhan I, Şenöz Oktay, Varım Perihan, Doğan Abdullah, Dursun Atakan, Unkun Tuba, Çetin İlyas, Gökalp Murat, Tanık Veysel O, Aktük İbrahim F, Çakal Beytullah, Keskin Kudret, Güner Ezgi G, Şimşek Aybüke, Ekiz Muhammet A, Üzel Seda T, Bulus Çağdaş, Çiloğlu Koray, Göksu Muhammed M, Çalık Ali N, Boztosun Bilal
Department of Cardiology University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul Turkey.
Department of Cardiology Medipol University Istanbul Turkey.
J Am Heart Assoc. 2025 Jun 17;14(12):e040166. doi: 10.1161/JAHA.124.040166. Epub 2025 May 21.
The comparison of outcomes of mini-crush (MCT) versus double kissing crush (DKC) techniques for complex left main bifurcation (LMB) lesions is still lacking. This investigation aimed to assess the long-term outcomes of patients who underwent MCT or DKC for LMB disease.
From 2014 to 2024, patients who underwent percutaneous coronary intervention for complex LMB lesions were retrospectively collected. The primary end point was major adverse cardiac events as the combination of cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization during follow-up. The secondary end point was measured as major adverse cardiovascular and cerebral events including all-cause death, target vessel revascularization, target vessel myocardial infarction, stent thrombosis, and stroke.
This large-scale multicenter (n=13) observational study included a total of 531 consecutive patients (men: 405 [76.3%], mean age: 63.16±11.26 years) with complex LMB lesions who underwent percutaneous coronary intervention. The initial revascularization strategy was MCT in 313 (59%) patients and DKC in 218 (41%) patients. The number of balloons used (5.91±1.53 versus 6.72±1.70, <0.001) and procedure time (66.60±24.20 versus 72.97±19.97 minutes, <0.001) were notably lower in the MCT group. In the overall population, the long-term major adverse cardiac events (hazard ratio [HR], 0.704; =0.169) and major adverse cardiovascular and cerebral events (HR, 0.660; =0.079) did not differ in individuals with complex LMB lesions treated with MCT and DKC. Other end points were also comparable between the 2 groups.
In complex LMB lesions, risk-adjusted major adverse cardiac events and major adverse cardiovascular and cerebral events rates were comparable between both techniques, with a nonsignificant trend favoring DKC at long-term follow-up.
URL: https://www.clinicaltrials.gov; Unique Identifier: NCT06546748.
对于复杂左主干分叉（LMB）病变，仍缺乏对迷你挤压术（MCT）与双吻挤压术（DKC）疗效的比较。本研究旨在评估接受MCT或DKC治疗LMB疾病患者的长期疗效。
回顾性收集2014年至2024年接受经皮冠状动脉介入治疗复杂LMB病变的患者。主要终点是随访期间主要不良心脏事件，定义为心源性死亡、靶血管心肌梗死或临床驱动的靶病变血运重建的组合。次要终点为主要不良心血管和脑血管事件，包括全因死亡、靶血管血运重建、靶血管心肌梗死、支架血栓形成和中风。
这项大规模多中心（n = 13）观察性研究共纳入531例连续接受经皮冠状动脉介入治疗的复杂LMB病变患者（男性：405例[76.3%]，平均年龄：63.16±11.26岁）。初始血运重建策略为MCT的患者有313例（59%），DKC的患者有218例（41%）。MCT组使用的球囊数量（5.91±1.53对6.72±1.70，<0.001）和手术时间（66.60±24.20对72.97±19.97分钟，<0.001）显著更低。在总体人群中，接受MCT和DKC治疗的复杂LMB病变患者的长期主要不良心脏事件（风险比[HR]，0.704；P = 0.169）和主要不良心血管和脑血管事件（HR，0.660；P = 0.079）无差异。两组的其他终点也具有可比性。
在复杂LMB病变中，两种技术调整风险后的主要不良心脏事件和主要不良心血管和脑血管事件发生率相当，长期随访中DKC有不显著的优势趋势。
