Bernard Chevalier, MD, Luc Cornillet, MD, Frederic Bouisset, MD, PHD, Laurent Delorme, MD, Stephane Champagne, MD, Philippe Brunel, MD, Katrien Blanchart, MD, Giuseppe Ferrante, MD, PHD, Manuel Pan, MD, Pedro Goncalves, MD, Antoinette Neylon, MD, Benoit Lattuca, MD, PHD, the KISS Trial Group
DOI: jacc.org/doi/10.1016/j.jcin.2026.02.012
Abstract
Background
Although provisional stenting is the recommended strategy for most coronary bifurcation lesions, the clinical benefit of additional side branch (SB) intervention remains debated.
Objectives
The aim of this study was to determine whether a conservative strategy without systematic SB intervention (SBI) is noninferior to systematic SB intervention regarding periprocedural events.
Methods
The multicenter, international KISS (Keep Bifurcation Single Stenting Simple) trial randomized patients with non–left main bifurcation lesions to 2 groups: no SBI or SBI following main branch stenting with the Resolute Onyx drug-eluting stent and a proximal optimization technique without impairment of SB flow. The primary endpoint was periprocedural myocardial infarction (MI) or myocardial injury, according to the Academic Research Consortium 2 definition. Secondary endpoints included procedural complications and 12-month clinical outcomes, including target lesion failure, defined as the composite of cardiac death, target vessel MI, and target lesion revascularization.
Results
Among the 616 included patients, 81% were treated for chronic coronary disease, and the bifurcation mainly involved was between the left anterior descending coronary artery and the diagonal. In the no-SBI group, an intervention on the SB was required in 2.0% of patients (n = 6). Periprocedural MI or myocardial injury occurred in 4.1% (n = 11) in the no-SBI group vs 5.7% (n = 16) in the SBI group (P < 0.001 for noninferiority; P = 0.38 for superiority). There was no significant interaction with age, sex, Medina classification, or SB residual stenosis. Procedure time, radiation dose, and contrast use were significantly lower in the no-SBI group. Procedural complications were rare, but SB dissection was more frequently observed in the SBI group (2.9% vs 0.0%; P = 0.004). There was no difference in target lesion failure at 1 year (4.9% [n = 15] vs 6.4% [n = 20] in the no-SBI and SBI groups respectively; P = 0.442).
Conclusions
The KISS trial demonstrates that a conservative strategy without systematic SB intervention is associated with very rare procedural complications and is noninferior to a systematic SB intervention regarding periprocedural MI and myocardial injury.
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