Predictors of target lesion failure after percutaneous coronary intervention with a drug-coated balloon for de novo lesions

Tetsumin Lee ¹, Takashi Ashikaga ¹, Toshihiro Nozato ¹

⁰Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan.

Eurointervention : Journal of Europcr in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology +

|

July 1, 2024

View abstract on PubMed

Summary

Target lesion failure after drug-coated balloon treatment for coronary artery lesions is linked to patients on hemodialysis, severe calcification, and lack of post-procedure dissection. These factors are crucial for predicting outcomes in percutaneous coronary intervention.

Area Of Science

Cardiology
Interventional Cardiology
Biomedical Engineering

Background

Limited data exist on factors predicting target lesion failure (TLF) after drug-coated balloon (DCB) angioplasty for de novo coronary artery lesions.
Optical coherence tomography (OCT) findings are underutilized in understanding TLF determinants.
Percutaneous coronary intervention (PCI) with DCB is a key treatment modality for coronary artery disease.

Purpose Of The Study

To identify factors associated with TLF in de novo coronary artery lesions treated with DCB.
To investigate the role of pre- and post-PCI OCT findings in predicting TLF.
To analyze the impact of patient comorbidities and lesion characteristics on TLF events.

Main Methods

Retrospective analysis of 328 de novo coronary artery lesions treated with DCB without stenting.
Inclusion of pre- and post-procedure OCT imaging for all lesions.
Categorization of patients into groups with and without TLF (cardiac death, myocardial infarction, target lesion revascularization).

Main Results

TLF occurred in 9.5% of patients at a median follow-up of 460 days.
Hemodialysis (HD) requirement (29.0% vs 10.8%), severe calcification (calcium arc 215° vs 104°), and absence of OCT medial dissection (16.1% vs 60.9%) were associated with TLF.
Independent predictors of TLF included HD (HR 2.26), maximum calcium arc (per 90°, HR 1.34), and absence of post-PCI medial dissection (HR 8.24).

Conclusions

Hemodialysis, severe lesion calcification, and absence of post-PCI medial dissection are significant predictors of TLF in de novo coronary lesions treated with DCB.
OCT imaging provides valuable insights into the mechanisms of TLF.
Risk stratification and tailored treatment strategies are warranted for patients undergoing DCB angioplasty.