Mini-Crush Versus Double Kissing Crush in Bifurcation Percutaneous Coronary Intervention: Insights From Progress-Bifurcation Registry

Abstract

There are limited data on the use of the mini-crush technique in 2-stent bifurcation percutaneous coronary intervention (PCI). Observational, multicenter (n = 7), international cohort study between 2013 and 2025, as part of the Prospective Global Registry of Percutaneous Coronary Intervention in Bifurcation Lesions (PROGRESS-BIFURCATION, NCT05100992). We evaluated procedural characteristics of patients who underwent bifurcation stenting using the mini-crush in comparison to the double kissing (DK) crush techniques. Among 2,508 bifurcation PCIs (2,284 patients), 184 (7.3%) underwent mini-crush and 257 (10.2%) DK-crush. Patients undergoing DK-crush were more likely to undergo intravascular imaging (41.9% vs 21.3%, p < 0.001). There was no difference in technical (98.4% vs 98.8%, p = 0.70) and procedural success (94.2% vs 94.9%, p = 0.77), as well as in-hospital MACE (5.0% vs 4.5%, p = 0.84). Mini-crush was associated with shorter procedural (90 [58–127] vs 107 [73–172.5] min) and fluoroscopy (24 [15.5–34.1] vs 30 [21.6–44] min) times. During a median follow-up of 754 days, as compared to DK-crush, there was a trend towards higher risk for MACE (29.8% vs 20.9%; p = 0.09) with mini-crush. Adjusted analyses with propensity score matching (aHR 1.73; 95% CI: 0.81–3.71; p = 0.14) showed no difference in MACE. In patients undergoing PCI for bifurcation lesions, the mini-crush technique had similar rates of technical and procedural success and in-hospital MACE as DK-crush and was associated with lower fluoroscopy time and procedural time. While no statistically significant differences were observed during follow-up, there was a numerical trend towards higher risk for adverse events with mini crush, and thus larger, prospective, controlled trials are needed. © 2025 Elsevier Inc.