Drug-eluting balloons versus drug-eluting stents for small vessel coronary artery disease: a meta-analysis

We aimed to conduct a network meta-analysis of treatments for small vessels coronary artery disease between drug-eluting balloon (DEB) and drug-eluting stent (DES).

A meta-analysis comparing DEB and DES outcomes was performed using the Medline, Embase, and Cochrane databases. The primary outcome was target lesion revascularization (TLR) or target vessel revascularization (TVR), and myocardial infarction (MI), death and major adverse cardiovascular events (MACE) were secondary outcomes. A total of six studies on 1813 patients were included.

There was no significant difference in rates of TLR or TVR in the patients treated with the DEB strategy compares with the DES strategy [odds ratio (OR) = 0.96, 95% confidence interval (CI) 0.57-1.61, P = 0.89] within a follow-up period of 9-24 months. There was a significant reduction in rates of MI and death in the patients treated with a DCB strategy compared with those treated with a DES strategy (3.7%, 17 of 460 vs 6.1%, 36 of 595; 2.4%, 11 of 460 vs 6.1%, 36 of 595, respectively), and this difference was statistically significant (OR = 0.53, 95% CI 0.29-0.96, P = 0.04; OR = 0.44, 95% CI 0.22-0.88, P = 0.02, respectively). There was no difference between DEB and DES strategies in rates of MACE (OR = 0.94, 95% CI 0.66-1.33, P = 0.73).

In summary, this study demonstrates that treatment of small vessel (diameter ≤ 3 mm) coronary artery disease (CAD) with DEB may lead to improving outcomes compared with the use of DES within a follow-up period of 9-24 months. Further large clinical trials are needed to verify this conclusion.