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Paclitaxel-Coated Balloon Angioplasty Versus Drug-Eluting Stent in Acute Myocardial Infarction: The REVELATION

Nicola S Vos1, Nick D Fagel1, Giovanni Amoroso1

  • 1Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, the Netherlands.

JACC. Cardiovascular Interventions
|May 26, 2019
PubMed

Insights

Drug-coated balloons (DCB) are as effective as drug-eluting stents (DES) for treating ST-segment elevation myocardial infarction (STEMI). This DCB strategy is a safe and feasible alternative for primary percutaneous coronary intervention in STEMI patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Devices

Background:

  • Drug-eluting stents (DES) improve outcomes in ST-segment elevation myocardial infarction (STEMI) primary percutaneous coronary intervention (PCI) regarding repeat revascularization but not mortality.
  • Drug-coated balloons (DCB) offer a potential alternative to DES, aiming to reduce restenosis seen with plain balloon angioplasty without the drawbacks of stenting.

Purpose of the Study:

  • To compare the efficacy and safety of a drug-coated balloon (DCB) strategy versus drug-eluting stent (DES) in primary PCI for STEMI.

Main Methods:

  • The prospective, randomized REVELATION trial enrolled 120 patients with STEMI undergoing primary PCI.
  • Patients with nonseverely calcified culprit lesions were randomized to DCB or DES after pre-dilatation.
  • The primary endpoint was fractional flow reserve (FFR) at 9 months.

Main Results:

  • At 9 months, mean FFR was 0.92 ± 0.05 in the DCB group (n=35) and 0.91 ± 0.06 in the DES group (n=38) (p=0.27), demonstrating noninferiority.
  • One case of abrupt vessel closure occurred in the DCB group.
  • Two patients (one in each group) required target lesion revascularization by 9 months.

Conclusions:

  • In STEMI, a DCB strategy is noninferior to DES regarding FFR at 9 months.
  • The DCB approach appears to be a safe and feasible treatment option for primary PCI in STEMI.
Abstract

Keywords:
ST-segment elevation myocardial infarctiondrug-coated balloonfractional flow reserveprimary percutaneous coronary intervention

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