Table 5.
Recent RCTs of Stenting Strategy for Distal Left Main Bifurcations
| DKCRUSH V Trial | EBC-MAIN Trial | |
|---|---|---|
| Year of publication | 2017 | 2021 |
| Design | Provisional strategy vs DK crush | Provisional strategy vs up-front 2-stent strategy |
| Number of patients | 482 | 467 |
| Mean age, y | 64.5 | 71.1 |
| Male sex, % | 80.2 | 76.9 |
| Diabetes, % | 27.2 | 27.4 |
| Sites | 26 sites (23 sites in Asia, 2 sites in United States, 1 site in Italy) | 31 sites in 11 European countries |
| Operator experience | ≥300 PCI/y and ≥20 left main PCI | ≥150 PCI/y |
| Lesion type | True unprotected left main bifurcation | True unprotected left main bifurcation |
| Anatomic complexity | ||
| Mean SYNTAX score | 30.6 | 22.9 |
| Distal bifurcation angle | 78° | 81.3° |
| Length of side branch lesion, mm | 16.4 | 6.9 |
| Complex bifurcation, % | 31.5 | Not classified |
| Use of IVUS guidance | Not mandated, 41.7% | Not mandated, 32.5% |
| Up-front 2-stent strategy | DK crush | Culotte (53%), T/TAP (33%), DK crush (5%) |
| Conversion rate to 2-stent in provisional strategy, % | 47 | 22 |
| Stents used in the study | Xience V (Abbott Vascular Inc), Endeavor Resolute (Medtronic Inc), Firebird 2 (MicroPort Medical) | Resolute Onyx (Medtronic Inc) |
| Primary endpoint | Target lesion failure, defined as a composite of cardiac death, target vessel MI, or target lesion revascularization | Death, MI, or target lesion revascularization |
| Key findings (provisional vs 2 stent) | 1 y: 10.7% vs 5.0%; P = 0.02 3 y: 16.9% vs 8.3%; P = 0.006 |
1 y: 14.7% vs 17.7%; P = 0.34 |