Double-kissing culotte versus culotte in acute coronary syndrome: two-year results from the LSCBR registry

Abstract Aims Robust data comparing outcomes of the double-kissing (DK) culotte technique to other two-stent strategies of bifurcation percutaneous coronary intervention (PCI) remain lacking. In this two-year observational study, we compared PCI outcomes using the DK culotte technique versus the conventional culotte technique in patients with bifurcation lesions responsible for acute coronary syndrome (ACS). Methods and Results This two-centre, observational, retrospective study included patients with ACS undergoing bifurcation PCI involving both left main and non-left main bifurcations. The study population comprised patients presenting with NSTEMI, STEMI, or unstable angina. Of 12,132 screened patients, 117 and 122 underwent DK culotte and culotte PCIs, respectively. After applying the propensity score nearest matching to balance baseline characteristics, the final groups consisted of 117 patients in the DK culotte group and 53 in the culotte group. The primary endpoint was 2-year target lesion failure (TLF), defined as cardiovascular death, target vessel myocardial infarction, or clinically indicated target lesion revascularisation (TLR). Secondary endpoints included major adverse cardiac events (MACE), TLR, stent thrombosis and restenosis. At 2 years, TLF (8.5% vs 18.9%; p=0.05) and MACE (16.2% vs 35.8%; p=0.01) were significantly lower in the DK culotte group compared with the culotte group. Stent restenosis (5.1% vs 11.3%; p=0.13), TLR (6.8% vs 15.1%; p=0.07), and stent thrombosis (2.6% vs 9.4%; p=0.06) all showed no significant differences. Results This study assessed the mid-term outcomes of PCI in patients with bifurcation lesions responsible for ACS, comparing the DK culotte technique with the conventional culotte technique. A significant reduction in TLF and MACE was observed in the DK culotte group.