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Drug-Coated Balloon Versus Drug-Eluting Stent for Large Coronary Arteries in Patients Presenting With STEMI: A

Ahmed Mohamed Elbeny1, Mohamed Hamouda Elkasaby2, Tamer Ahmed Fouad1

  • 1Cardiovascular Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|November 24, 2025
PubMed

Insights

Drug-coated balloons (DCB) offer a safe alternative to drug-eluting stents (DES) for treating large coronary arteries in ST-elevation myocardial infarction (STEMI) patients. This meta-analysis found no significant differences in major adverse cardiac events or revascularization rates between DCB and DES.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Biomedical Engineering

Background:

  • Drug-coated balloons (DCB) are a stentless option for percutaneous coronary intervention (PCI).
  • Their efficacy in ST-elevation myocardial infarction (STEMI) involving large de novo coronary arteries requires further evaluation.
  • Comparison with drug-eluting stents (DES) is crucial for treatment guidelines.

Purpose of the Study:

  • To systematically review and meta-analyze clinical and angiographic outcomes of DCB versus DES in STEMI patients.
  • To assess the safety and effectiveness of DCB in large de novo coronary lesions (≥2.5 mm).
  • To compare target lesion revascularization (TLR), major adverse cardiac events (MACE), and angiographic parameters.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials and observational studies.
  • Comprehensive literature search of PubMed, Scopus, and Web of Science up to July 1, 2025.
  • Inclusion of studies involving STEMI patients with large de novo coronary lesions treated with DCB or DES.

Main Results:

  • No significant differences were observed in TLR, MACE, cardiac death, or myocardial infarction (MI) between DCB and DES.
  • Post-PCI minimal lumen diameter (MLD) was greater with DES, but follow-up MLD did not differ significantly.
  • Late lumen loss (LLL) was comparable between the two treatment groups.

Conclusions:

  • Drug-coated balloons (DCB) demonstrate comparable clinical and angiographic outcomes to drug-eluting stents (DES) in STEMI patients with large de novo coronary lesions.
  • DCB represent a safe and effective stentless alternative for this patient population.
  • Further research may refine the role of DCB in complex coronary interventions.

Keywords:
STEMIde novo lesiondrug‐coated balloondrug‐eluting stentlarge coronary arterymeta‐analysisprimary PCI

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