Clinical update
Complex bifurcation PCI: DKCRUSH VIII puts IVUS optimization in focus
A randomized trial in complex coronary bifurcation PCI found lower one-year target-vessel failure with IVUS guidance when operators achieved prespecified optimization targets. The result is clinically important but applies to a highly selected DK-crush setting—not every bifurcation PCI.
- Prepared by
- Iraq Cardiology Editorial Team
- Source authors
- Xiaofei Gao et al.
- Reading time
- 4 min
Key takeaway
In the DKCRUSH VIII randomized trial, intravascular ultrasound (IVUS)-guided PCI was associated with lower one-year target-vessel failure than angiography-guided PCI in selected complex coronary bifurcation lesions treated predominantly with a two-stent DK-crush strategy.
What the study examined
The multicenter, open-label trial enrolled 555 patients at 24 centers in China. Participants had complex bifurcation lesions by DEFINITION criteria and were assigned to IVUS-guided or angiography-guided PCI. The primary endpoint combined cardiac death, target-vessel myocardial infarction, and clinically driven target-vessel revascularization at one year.
What happened at one year
The primary endpoint occurred in 6.1% of the IVUS-guided group and 14.7% of the angiography-guided group (hazard ratio 0.40; 95% CI 0.23–0.71; P=0.002). The report links benefit to achieving IVUS-defined optimization targets, rather than treating IVUS as a stand-alone intervention.
Practice context
This is useful contemporary evidence for meticulous lesion preparation, stent expansion, and optimization in complex bifurcation work. It does not mean that one technique or imaging pathway should be applied uniformly. Nearly all procedures used DK-crush, 44.8% involved the left main, and all sites were in one national setting; local expertise, equipment, anatomy, and the wider evidence base remain essential.
Source
Gao X, Kan J, Chen Y, et al. *IVUS or Angiography Guidance for Percutaneous Coronary Intervention in Complex Coronary Bifurcation Lesions: The DKCRUSH VIII Randomized Clinical Trial.* JACC. Published 30 March 2026.
*Educational editorial summary only; not patient-specific procedural advice.*
Professional discussion starter
Turn reading into a balanced conversation.
Prompts for professional reflection—not individual treatment advice.
- 1Which element of the source most changes how your team would frame Interventional cardiology and coronary bifurcation PCI?
- 2Which limitation or context should be made explicit before discussing application?
- 3What question is worth taking to a journal club or multidisciplinary meeting?
Continue reading
Related updates
Clinical update
When a Coronary Stent Fails: Can Stentectomy Offer a Way Forward?
A new review suggests that catheter-based removal of a fully deployed coronary stent may be feasible in carefully selected cases of complex stent failure — but only within a highly specialized, imaging-led strategy.
Read updateClinical update
Quick Hit: AF care quality moves from a checklist to a care pathway
The 2026 AHA/ACC atrial-fibrillation performance and quality measures put initial evaluation, stroke-risk documentation, prevention, equity, and shared decisions into one visible care-quality framework.
Read update