DKCRUSH VIII: IVUS‑Guided PCI Superior to Angiography‑Guided PCI in Complex Coronary Lesions

In patients undergoing two‑stent double‑kissing (DK) crush PCI for complex coronary bifurcation lesions, IVUS‑guided PCI significantly reduced target‑vessel failure compared with angiography‑guided PCI, according to the DKCRUSH VIII trial presented at ACC.26 and published in JACC. 

Conducted at 24 centers in China, the open‑label superiority trial randomized 555 patients (median age 67, 78% men) with DEFINITION‑defined complex bifurcation lesions to either IVUS‑guided or angiography‑guided DK‑crush stenting, with nearly all treated using the DK crush technique.

At one year, the composite of cardiac death, target‑vessel myocardial infarction (TVMI), or clinically driven target‑vessel revascularization (TVR) occurred in 6.0% of the IVUS‑guided group versus 14.7% of the angiography‑guided group (HR 0.40; 95% CI 0.23–0.71; p = 0.002), driven mainly by fewer TVMI and TVR events. The benefit was consistent across all 12 prespecified subgroups and IVUS‑guided procedures had fewer procedural complications. 

The authors emphasize that the advantage came from achieving IVUS‑defined optimization targets—such as proper stent expansion, apposition, and bifurcation‑side‑branch coverage—rather than IVUS use alone.

In an accompanying editorial, experts argue that intravascular imaging guidance should now be considered as routine in coronary stenting as cineangiography itself, and that the key question is no longer whether to use imaging, but which modality (IVUS or optical coherence tomography) and how best to integrate it into practice. 

For interventional cardiologists, DKCRUSH VIII supports routine IVUS‑guided DK crush for complex bifurcation lesions, particularly when precise optimization is critical to long‑term outcomes.