What did DKCRUSH-VIII show at ACC 2026?

IVUS guidance for DK crush stenting in complex bifurcation lesions — results from 556-patient multicenter Chinese trial presented at ACC.26 and published in JACC.

What is the clinical evidence from this study?

Study design: RCT. Population: Complex coronary bifurcation lesions (n=555). Intervention: IVUS-guided PCI vs. Angiography-guided PCI. Primary outcome: Composite of target vessel failure (cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularization) (HR 0.40, 95% CI 0.23-0.71, p=0.002).

What does this research mean for the field?

IVUS-guided percutaneous coronary intervention significantly reduces target vessel failure at 1 year compared to angiography-guided intervention in patients with complex coronary bifurcation lesions. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aimed to compare the effects of IVUS-guided PCI and angiography-guided PCI on outcomes in patients with complex bifurcation lesions.

This research is Trending!

DKCRUSH-VIIIJournal of the American College of Cardiology

IVUS Versus Angiography Guidance for Percutaneous Coronary Intervention in Bifurcation Lesions

IVUS or Angiography Guidance for Percutaneous Coronary Intervention in Complex Coronary Bifurcation Lesions

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Why the trial?

This trial was conducted to determine whether IVUS-guided PCI improves outcomes compared to angiography-guided PCI in patients with complex coronary bifurcation lesions undergoing double kissing (DK) crush stenting, addressing uncertainty about the optimal imaging guidance in this setting.

Does IVUS-guided PCI reduce target vessel failure compared to angiography-guided PCI in patients with complex coronary bifurcation lesions?

Key result

IVUS-guided PCI significantly reduced target vessel failure at 1 year compared to angiography-guided PCI in complex coronary bifurcation lesions (6.1% vs 14.7%; HR 0.40; 95% CI 0.23-0.71; P=0.002).

Authors

XGXiaofei GaoNanjing Medical University JKJing KanNanjing Medical University YCYan ChenZhengzhou Central Hospital

Discussion

Member takes

Overview

Supports IVUS-guided PCI as preferred for complex bifurcation lesions; extends RCT evidence to DK crush stenting in this high-risk anatomy.

Key Points

This study aimed to compare the effects of IVUS-guided PCI and angiography-guided PCI on outcomes in patients with complex bifurcation lesions.
Conducted a multicenter, randomized, open-label trial across 24 centers in China.
Patients with complex bifurcation lesions were assigned 1:1 to IVUS-guided or angiography-guided PCI.
The primary endpoint was a composite of target vessel failure at 1 year after randomization.
Primary endpoint event occurred in 17 patients (6.1%) in the IVUS group versus 41 patients (14.7%) in the angiography group (HR: 0.40; 95% CI: 0.23-0.71; P = 0.002).
Benefits were mainly due to decreases in target vessel myocardial infarction and revascularization.
IVUS-defined optimization had a significant role in achieving better outcomes.

Study Design

Type

RCT (n=555)

Blinding

Open-label

Randomization

1:1

Multicenter

Yes

Structured PICO

Does IVUS-guided PCI reduce target vessel failure compared to angiography-guided PCI in patients with complex coronary bifurcation lesions?

Population

555 patients with clinical indications for PCI and a complex bifurcation lesion based on DEFINITION criteria (particularly side branch lesion length ≥10 mm)

Intervention

Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI)

Comparator

Angiography-guided percutaneous coronary intervention (PCI)

Outcome

Composite of target vessel failure, defined as cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularization at 1 year after randomizationcomposite

IVUS-guided PCI significantly reduces target vessel failure at 1 year compared to angiography-guided PCI in complex coronary bifurcation lesions treated with the DK crush technique.

Main Result

Effect estimate: HR 0.40 (95% CI 0.23-0.71)

Absolute Event Rate: 6.1% vs 14.7%

p-value: p=0.002

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Cite This Study

Gao et al. (2026) conducted an RCT in Complex coronary bifurcation lesions (n=555). IVUS-guided PCI vs. Angiography-guided PCI was evaluated on Composite of target vessel failure (cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularization) (HR 0.40, 95% CI 0.23-0.71, p=0.002). IVUS-guided PCI significantly reduced target vessel failure at 1 year compared to angiography-guided PCI in complex coronary bifurcation lesions (6.1% vs 14.7%; HR 0.40; 95% CI 0.23-0.71; P=0.002).

synapsesocial.com/papers/69efc6fb5ce2fbd289d537f0 https://doi.org/10.1016/j.jacc.2026.01.081

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This research is Trending!

DKCRUSH-VIIIJournal of the American College of Cardiology

IVUS Versus Angiography Guidance for Percutaneous Coronary Intervention in Bifurcation Lesions

IVUS or Angiography Guidance for Percutaneous Coronary Intervention in Complex Coronary Bifurcation Lesions

View Full Paper

Why the trial?

Does IVUS-guided PCI reduce target vessel failure compared to angiography-guided PCI in patients with complex coronary bifurcation lesions?

Key result

IVUS-guided PCI significantly reduced target vessel failure at 1 year compared to angiography-guided PCI in complex coronary bifurcation lesions (6.1% vs 14.7%; HR 0.40; 95% CI 0.23-0.71; P=0.002).

Authors

XGXiaofei GaoNanjing Medical University JKJing KanNanjing Medical University YCYan ChenZhengzhou Central Hospital

Discussion

Member takes

Overview

Supports IVUS-guided PCI as preferred for complex bifurcation lesions; extends RCT evidence to DK crush stenting in this high-risk anatomy.

Key Points

This study aimed to compare the effects of IVUS-guided PCI and angiography-guided PCI on outcomes in patients with complex bifurcation lesions.
Conducted a multicenter, randomized, open-label trial across 24 centers in China.
Patients with complex bifurcation lesions were assigned 1:1 to IVUS-guided or angiography-guided PCI.
The primary endpoint was a composite of target vessel failure at 1 year after randomization.
Primary endpoint event occurred in 17 patients (6.1%) in the IVUS group versus 41 patients (14.7%) in the angiography group (HR: 0.40; 95% CI: 0.23-0.71; P = 0.002).
Benefits were mainly due to decreases in target vessel myocardial infarction and revascularization.
IVUS-defined optimization had a significant role in achieving better outcomes.

Study Design

Type

RCT (n=555)

Blinding

Open-label

Randomization

1:1

Multicenter

Yes

Structured PICO

Does IVUS-guided PCI reduce target vessel failure compared to angiography-guided PCI in patients with complex coronary bifurcation lesions?

Population

555 patients with clinical indications for PCI and a complex bifurcation lesion based on DEFINITION criteria (particularly side branch lesion length ≥10 mm)

Intervention

Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI)

Comparator

Angiography-guided percutaneous coronary intervention (PCI)

Outcome

Composite of target vessel failure, defined as cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularization at 1 year after randomizationcomposite

IVUS-guided PCI significantly reduces target vessel failure at 1 year compared to angiography-guided PCI in complex coronary bifurcation lesions treated with the DK crush technique.

Main Result

Effect estimate: HR 0.40 (95% CI 0.23-0.71)

Absolute Event Rate: 6.1% vs 14.7%

p-value: p=0.002

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View Full Paper

Cite This Study

synapsesocial.com/papers/69efc6fb5ce2fbd289d537f0 https://doi.org/10.1016/j.jacc.2026.01.081

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View Full Paper