Sirolimus-coated balloon versus drug-eluting stent for complex coronary lesions. A propensity matched comparison

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Technology Evaluation

Background:

• Drug-eluting stents (DES) are standard for complex coronary artery disease (CAD) but have associated stent-related events.
• Sirolimus-coated balloon (SCB) angioplasty is an emerging alternative requiring comparative evaluation.
• Complex PCI necessitates thorough assessment of novel treatment modalities.

Purpose of the Study:

• To compare the safety and efficacy of SCB-based angioplasty versus new-generation DES.
• To evaluate outcomes in patients with complex coronary artery disease undergoing PCI.
• To determine the incidence of net adverse cardiovascular events (NACE) between SCB and DES treatments.

Main Methods:

• A comparative study analyzing data from the EASTBOURNE (SCB) and COMPLEX (DES) registries.
• Propensity score matching was used to create comparable patient groups (512 patients analyzed).
• Primary endpoint was NACE, defined as death, target lesion revascularization, myocardial infarction, or major bleeding (BARC).

Main Results:

• SCB angioplasty demonstrated significantly lower NACE rates compared to DES (3.9% vs. 10.5%, p=0.003) at 1-year follow-up.
• Major bleeding events were substantially reduced with SCB (0.4% vs. 6.6%, p=0.001).
• Adjusted Cox models revealed a significantly lower hazard of NACE (HR 0.23) and all-cause mortality (HR 0.07) with SCB.

Conclusions:

• SCB angioplasty offers an advantage over DES in treating complex CAD, reducing NACE and major bleeding without compromising ischemic outcomes.
• SCB angioplasty presents a viable alternative to DES for carefully selected patients with complex coronary lesions.
• The findings support SCB as a potentially safer treatment option in complex PCI settings.