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 preferred bifurcation stenting techniques. Double kissing mini-culotte (DKC) stenting is the most updated and modified form of culotte stenting recommended by the current guidelines. We aimed to compare the DKC and the mini-culotte (MC) technique in true non-left main coronary bifurcation lesion (CBL).


METHODS
A total of 200 patients with non-left main CBL undergoing percutaneous coronary intervention were categorized as MC stenting (n=92) and DKC stenting (n=108) groups. The primary endpoint of the study was target lesion failure (TLF) which was a composite outcome of cardiac death, target vessel myocardial infarction (TVMI) and target lesion revascularization (TLR) at 1-year and 3-year follow up periods.


RESULTS
The incidence of TLF at 1-year [7 (7.6%); 1 (0.9%), p=0.017] and 3-year [18 (19.6%); 6 (5.6%), p=0.002] were significantly lower in the DKC that were mainly driven by the reduced TLR at 1-year [6 (6.5%); 1 (0.9%), p=0.033] and 3-year [13 (14.1%); 5 (4.6%), p=0.018]. The number of patient with TVMI [4 (4.3%); 3 (2.8%), p=0.551] and cardiac death [5 (5.4%); 1 (0.9%), p=0.064] was lower in the DKC at 3-year follow-up period.


CONCLUSION
In the true non-left main CBL, the DKC technique had a lower incidence of TLF and TLR at 3-year compared to MC technique.