Webinar 1 | Bifurcation Imaging-Slides: Late-Breaking from ACC: IVUS or Angiography Guidance for PCI in Complex Coronary Bifurcation Lesions, Dr. Shao-Liang Chen

Slides: Late-Breaking from ACC: IVUS or Angiography Guidance for PCI in Complex Coronary Bifurcation Lesions, Dr. Shao-Liang Chen

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Pdf Summary

The DKCRUSH VIII randomized trial compared intravascular ultrasound (IVUS)-guided versus angiography-guided percutaneous coronary intervention (PCI) in 555 patients with complex coronary bifurcation lesions, mostly treated with the double kissing (DK) crush technique. Patients were enrolled at 24 centers in China and had true complex bifurcation disease by DEFINITION criteria, including frequent left main involvement.<br /><br />At 1 year, the primary endpoint of target vessel failure (cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularization) was significantly lower with IVUS guidance: 6.1% versus 14.7% with angiography guidance (hazard ratio 0.40, 95% CI 0.23-0.71; P=0.002). The benefit was driven mainly by fewer target vessel myocardial infarctions and fewer repeat revascularizations. IVUS guidance also reduced all myocardial infarction, spontaneous MI, and clinically driven target lesion/target vessel revascularization. Rates of death and stent thrombosis were low and not significantly different.<br /><br />Procedurally, IVUS guidance led to larger stents/balloons, longer procedure time, and slightly higher contrast use, but angiographic success was similar between groups. Importantly, the trial found that the advantage of IVUS was largely achieved when operators met IVUS-defined optimization targets; patients with suboptimal IVUS results had outcomes similar to angiography-guided PCI.<br /><br />The authors conclude that in complex coronary bifurcation lesions treated with DK crush, IVUS-guided PCI improves 1-year clinical outcomes over angiography-guided PCI, but the benefit depends on achieving proper IVUS-based procedural optimization rather than simply using IVUS alone.

Keywords

IVUS-guided PCI

angiography-guided PCI

DK crush technique

coronary bifurcation lesions

target vessel failure

left main disease

percutaneous coronary intervention

myocardial infarction

stent optimization

randomized trial