Cardiovascular Outcomes of Drug-Coated Balloon Versus Drug-Eluting Stents for Femoropopliteal Peripheral Arterial...

Outcomes comparing drug-coated balloons (DCB) versus drug-eluting stents (DES) have not been sufficiently studied in femoropopliteal peripheral arterial disease (PAD).

This meta-analysis aims to compare outcomes of DES versus DCBs in femoropopliteal PAD and uses regression to rule out effect modifiers.

An online literature search was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis search strategy from inception till November 2022. STATA v.17 was used for statistical analysis to calculate odds ratios and for univariate meta-regression to rule out effect modifiers, including baseline characteristics and comorbidities.

A total of eight studies with 1261 patients underwent femoropopliteal peripheral arterial intervention (DCB, n = 670; DES, n = 591). There was no difference in the primary outcome of all-cause mortality and primary patency at 1 year and 2 years between DCB and DES. One-year clinically-driven target lesion revascularization (CD-TLR) was significantly lower in the DCB group (OR: 0.68; 95% CI = 0.47-0.98; p = 0.04); however, no significant difference was found in 2-year CD-TLR. Regarding secondary outcomes' analysis, major amputation, procedural success, and post-procedure ankle-brachial index (ABI) failed to reach statistical significance. Univariate meta-regression results showed no effect modification based on demographics, comorbidities, and lesion characteristics (p > 0.05) for all outcomes except 1-year CD-TLR and major amputation.

There was no significant difference in all-cause mortality and primary patency between DCB and DES for up to 2 years. DCB was associated with lower CD-TLR at 1 year, which was lost at 2 years of follow-up.