Drug-Coated Balloon-Based Versus Drug-Eluting Stent-Only Treatment in Patients With Chronic Kidney Disease

Chronic kidney disease (CKD) is associated with a high bleeding risk after percutaneous coronary intervention (PCI), but evidence on the efficacy of drug-coated balloon (DCB) treatment in this population remains limited. This study aimed to compare the bleeding risk of DCB-based PCI with that of drug-eluting stent (DES)-only PCI in patients with CKD. We retrospectively enrolled 415 consecutive patients with CKD who underwent DCB-based PCI and propensity score-matched them (1:1) to 415 patients who underwent conventional PCI with second-generation DES (DES-only group). CKD was defined as eGFR <60 mL/min/1.73 m². The primary end point was the incidence of major bleeding at 2 years, and the secondary end point was major adverse cardiovascular events (MACE). Baseline characteristics were comparable between the two groups. In the DCB-based group, 65.1% of patients were treated with DCB-only. At 2-year, DCB-based PCI group showed a significantly lower incidence of major bleeding than DES-only group (2.3% vs 5.9%; hazard ratio 0.41; 95% confidence interval 0.19-0.92; p = 0.030), whereas the incidence of MACE was comparable between groups (10.7% vs 13.0%; hazard ratio 0.77; 95% confidence interval 0.50-1.18; p = 0.230). Five cases of target lesion thrombosis occurred in the DES-only group, but none in the DCB-based group. In multivariable analysis, DCB-based PCI was independently associated with a lower risk of 2-year major bleeding. In conclusion, among patients with CKD, DCB-based PCI was associated with a significantly lower risk of major bleeding compared with DES-only PCI, without a significant difference in MACE. These findings suggest that DCB-based PCI may be a viable strategy to reduce bleeding events in patients with CKD.