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Drug-Eluting Balloons in Calcified Coronary Lesions: A Meta-Analysis of Clinical and Angiographic Outcomes
Borja Rivero-Santana1,2, Alfonso Jurado-Roman1,2, Guillermo Galeote1,2
1Cardiology Department, La Paz University Hospital, 28046 Madrid, Spain.
Insights
Drug-eluting balloons (DEBs) show comparable clinical outcomes to drug-eluting stents (DES) for calcified coronary lesions (CCLs). While DEBs have poorer acute results, they may offer improved long-term angiographic outcomes in CCL treatment.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Calcified coronary lesions (CCLs) present unique challenges in percutaneous coronary intervention (PCI).
- The clinical utility of drug-eluting balloons (DEBs) in treating CCLs remains incompletely understood.
- Drug-eluting stents (DES) are a common treatment modality for coronary artery disease.
Purpose of the Study:
- To compare the efficacy and safety of DEBs versus DES in patients with CCLs.
- To evaluate major adverse cardiac events (MACE) and other clinical outcomes at 12 months.
- To assess angiographic results, including acute gain and late lumen loss, after PCI and at follow-up.
Main Methods:
- A systematic meta-analysis of studies comparing DEBs and DES for CCLs.
- Searches conducted in PubMed, EMBASE, and Cochrane databases up to December 2023.
- Primary endpoint: 12-month MACE; secondary endpoints: clinical and angiographic outcomes.
Main Results:
- Five studies with 1141 patients and 1176 lesions were included.
- DEBs demonstrated comparable 12-month MACE, cardiac death, myocardial infarction, and target lesion revascularization rates to DES.
- DEBs showed inferior acute angiographic outcomes (acute gain, minimal lumen diameter) but superior late lumen loss at 12-month follow-up.
Conclusions:
- The DEB strategy is a viable alternative to DES for treating CCLs, offering comparable clinical outcomes.
- Despite initial angiographic disadvantages, DEBs may provide improved long-term angiographic results in calcified coronary lesions.
- Further research may elucidate the optimal role of DEBs in complex coronary lesion interventions.
Abstract:
Background: The usefulness of drug-eluting balloons (DEBs) has not been fully elucidated in calcified coronary lesions (CCLs). This meta-analysis aimed to evaluate the efficacy of DEBs compared to a drug-eluting stent (DES) in this setting. Methods: PubMed, EMBASE and Cochrane were searched through December 2023. The primary endpoint was 12 months major adverse cardiac events (MACE). Secondary endpoints included clinical outcomes and angiographic results after PCI and at a 12-month follow-up. Results: Five studies and a total of 1141 patients with 1176 coronary lesions were included. Overall, the DEB was comparable to DES in MACE (RR = 0.86, 95% CI: 0.62-1.19, p = 0.36), cardiac death (RR = 0.59, 95% CI: 0.23-1.53, p = 0.28), myocardial infarction (RR = 0.89, 95% CI: 0.25-3.24, p = 0.87) and target lesion revascularization (RR = 1.1, 95% CI: 0.68-1.77, p = 0.70). Although the DEB was associated with worse acute angiographic outcomes (acute gain; MD = -0.65, 95% CI: -0.73, -0.56 and minimal lumen diameter; MD = -0.75, 95% CI: -0.89, -0.61), it showed better results at 12 months follow-up (late lumen loss; MD = -0.34, 95% CI: -0.62, -0.07). Conclusions: This meta-analysis showed that the DEB strategy is comparable to DES in the treatment of CCLs in terms of clinical outcomes. Although the DEB strategy had inferior acute angiographic results, it may offer better angiographic results at follow-up.
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