Drug-Coated Balloons Versus Drug-Eluting Stents for Large Vessel Coronary Artery Disease: A Meta-Analysis

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Biomaterials in Medicine

Background:

• Large vessel coronary artery disease (CAD) necessitates effective revascularization strategies.
• Drug-eluting stents (DESs) are a common treatment, but concerns regarding long-term outcomes persist.
• Drug-coated balloons (DCBs) offer a stent-free alternative for percutaneous coronary intervention (PCI).

Purpose of the Study:

• To conduct a meta-analysis comparing the efficacy and safety of DCBs versus DESs for treating de novo large coronary lesions.
• To evaluate outcomes such as target lesion revascularization (TLR), bleeding events, minimal lumen diameter (MLD), and late lumen loss (LLL).

Main Methods:

• A systematic search of multiple databases (PubMed, Web of Science, Cochrane, CNKI, Wanfang) was performed.
• Included studies were randomized controlled trials (RCTs) and cohort studies comparing DCBs and DESs in patients with reference vessel diameter (RVD) > 2.75 mm.
• Data from 12 studies involving 2634 patients were pooled for meta-analysis.

Main Results:

• DCB treatment was non-inferior to DES for TLR (RR = 1.25, p = 0.27).
• DCB group showed significantly lower incidence of bleeding events (RR = 0.30, p = 0.0004).
• While post-intervention MLD was smaller with DCBs (RR = -0.37, p = 0.0007), follow-up MLD was comparable (RR = -0.03, p = 0.61), and DCBs exhibited less LLL (RR = -0.31, p < 0.0001).

Conclusions:

• DCBs are a safe and effective alternative to DESs for de novo large coronary lesions (RVD > 2.75 mm).
• DCBs demonstrate non-inferior efficacy and improved safety, particularly reduced bleeding, compared to DESs.
• The findings support DCBs as a viable option in PCI for specific patient populations.