Drug-Eluting Balloons in Calcified Coronary Lesions: A Meta-Analysis of Clinical and Angiographic Outcomes

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.