The DKCRUSH VIII randomised trial (presented at ACC.26; published in JACC) asks a practical cath-lab question: when treating complex coronary bifurcation lesions with the two-stent DK crush technique, does intravascular ultrasound (IVUS) guidance improve outcomes over angiography alone?
Design. 556 patients across 24 centres in China, randomised 1:1 to IVUS-guided versus angiography-guided DK crush (278 each).
Primary result. At 1 year, target-vessel failure occurred in 6.1% (IVUS) versus 14.7% (angiography), HR 0.40 (95% CI 0.23 to 0.71; P = 0.002). The benefit was driven by reductions in target-vessel MI (4.3% vs 9.4%), spontaneous MI (1.8% vs 6.1%), and target-vessel revascularisation (2.9% vs 7.6%). There were no significant differences in all-cause mortality, cardiac death, or definite/probable stent thrombosis.
The nuance that matters. Investigators emphasised that most of the benefit came from achieving IVUS-defined optimisation targets (adequate expansion, apposition, full lesion coverage) rather than from imaging use per se. IVUS helps when it changes what you do at the table.
Why it matters for central Gujarat. Complex bifurcation PCI is common in a high-burden CAD population. Where IVUS is available, using it to hit defined optimisation targets during DK crush may reduce repeat MIs and reinterventions, which matters for patients who travel long distances and value durable results. Where IVUS is not available, the trial reinforces the value of meticulous stent optimisation by whatever means are at hand.
Draft for review: single trial, Chinese population, specific two-stent (DK crush) technique. Verify the exact numbers, endpoint definitions and any class/level-of-evidence framing against the primary JACC paper before relying on it.