Clinical Outcomes of Double Kissing Culotte and Mini-Culotte Stenting in Non-Left Main Coronary Bifurcation Lesions: The OPTIMUM Trial

OBJECTIVE
Culotte stenting is one of the most commonly used bifurcation stenting techniques. Double kissing mini-culotte (DKC) stenting, a modified version of culotte stenting, is currently recommended by clinical guidelines. This study aimed to compare the outcomes of DKC and mini-culotte (MC) techniques in true non-left main coronary bifurcation lesions (CBLs).


METHOD
A total of 200 patients with non-left main CBLs undergoing percutaneous coronary intervention were assigned to either MC stenting (n = 92) or DKC stenting (n = 108). The primary endpoint was target lesion failure (TLF), defined as a composite of cardiac death, target vessel myocardial infarction (TVMI), and target lesion revascularization (TLR) at one- and three-year follow up.


RESULTS
The incidence of TLF was significantly lower in the DKC group at both one year [7 (7.6%) vs. 1 (0.9%), P = 0.017] and three years [18 (19.6%) vs. 6 (5.6%), P = 0.002], primarily driven by a reduction in TLR at one year [6 (6.5%) vs. 1 (0.9%), P = 0.033] and three years [13 (14.1%) vs. 5 (4.6%), P = 0.018]. Fewer patients experienced TVMI [4 (4.3%) vs. 3 (2.8%), P = 0.551] and cardiac death [5 (5.4%) vs. 1 (0.9%), P = 0.064] in the DKC group at three years.


CONCLUSION
In patients with true non-left main CBLs, the DKC technique was associated with a lower incidence of TLF and TLR at three years compared to the MC technique.