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Published on: October 26, 2016
Drug-Coated Balloon-Based Versus Drug-Eluting Stent-Only Treatment for Large Vessel Coronary Artery Disease
Eun-Seok Shin1, Mi Hee Jang1, Sunwon Kim2
1Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
Insights
Drug-coated balloon (DCB) angioplasty significantly reduced major adverse cardiac events in large vessel coronary artery disease compared to drug-eluting stents. This was primarily driven by a lower need for target vessel revascularization at two years.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Devices
Background:
- Drug-coated balloons (DCB) show promise in small vessel coronary disease.
- Limited evidence exists for DCB use in large vessel coronary artery disease (CAD).
Purpose of the Study:
- To evaluate the clinical effectiveness of DCB-based percutaneous coronary intervention (PCI) in patients with large vessel CAD.
- Compare DCB-based PCI outcomes against conventional PCI using second-generation drug-eluting stents (DES).
Main Methods:
- Retrospective analysis of 550 patients undergoing DCB-based PCI for large vessel CAD (reference diameter ≥ 3.0 mm).
- Propensity-matched 1:1 with 550 patients receiving DES-only PCI.
- Primary endpoint: 2-year major adverse cardiac events (MACE), including cardiac death, myocardial infarction, target lesion thrombosis, and target vessel revascularization (TVR).
Main Results:
- DCB-based PCI demonstrated a significantly lower 2-year MACE rate (4.3%) compared to DES-only PCI (9.7%).
- TVR rates were also significantly lower in the DCB group (3.4% vs. 7.5%).
- No significant differences were observed in cardiac death, myocardial infarction, or major bleeding between groups.
Conclusions:
- DCB-based PCI is a safe and effective strategy for large vessel CAD.
- This approach significantly reduces MACE and TVR compared to DES-only PCI at 2-year follow-up.
- DCB angioplasty offers a valuable alternative to stenting in select large vessel coronary interventions.
Background:
Drug-coated balloon (DCB) treatment has shown outcomes comparable to drug-eluting stent (DES) in small vessel coronary disease. However, evidence for its application in large vessel coronary artery disease (CAD) remains limited.
Aims:
This study evaluated the clinical impact of DCB-based percutaneous coronary intervention (PCI) in patients with large vessel CAD.
Methods:
We retrospectively enrolled 550 consecutive patients with reference vessel diameter ≥ 3.0 mm treated with DCB-based PCI and propensity-matched them 1:1 to 550 patients who underwent conventional PCI with second-generation DES (DES-only group). The primary endpoint was 2-year major adverse cardiac events (MACE), defined as a composite of cardiac death, non-fatal myocardial infarction, definite target lesion thrombosis, and target vessel revascularization (TVR).
Results:
In the DCB-based group, 390 patients (70.9%) were treated with DCB alone. Total device length was higher in the DCB group (40.0 ± 23.3 vs. 35.4 ± 23.3 mm; p = 0.001), whereas mean implanted stent length was shorter (9.6 ± 18.4 vs. 35.4 ± 23.3 mm; p < 0.001). The cumulative 2-year incidence of MACE was significantly lower after DCB-based PCI than after DES-only PCI (4.3% vs. 9.7%; hazard ratio: 0.43; 95% confidence interval: 0.26 to 0.70; p = 0.001). TVR was also lower in DCB-based PCI (3.4% vs. 7.5%; hazard ratio: 0.45; 95% confidence interval: 0.25 to 0.81; p = 0.008). There was no difference in cardiac death, myocardial infarction, or major bleeding.
Conclusion:
In patients with large vessel CAD, DCB-based PCI strategy was associated with a significant reduction in MACE compared with DES-only PCI at 2-year follow-up, primarily driven by a lower rate of TVR.
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