Drug-Coated Balloons in Side Branch Treatment in True Coronary Bifurcation Lesions: A Meta-Analysis and Systematic
Olivia Stainer1, Milica Milosavljevic1, Kevin Liou1,2,3
1Department of Cardiology, Bankstown Hospital, Sydney, NSW 2200, Australia.
Insights
Drug-coated balloons (DCBs) significantly reduce myocardial infarction (MI) and target lesion revascularisation (TLR) in coronary bifurcation lesions (CBLs) compared to plain old balloon angioplasty (POBA). DCBs also decrease late lumen loss (LLL) in the side branch (SB).
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Coronary bifurcation lesions (CBLs) present complex treatment challenges.
- Side branch (SB) patency is critical for successful CBL intervention.
- Drug-coated balloons (DCBs) offer a potential alternative to plain old balloon angioplasty (POBA) for SB treatment.
Purpose of the Study:
- To compare the efficacy of DCBs versus POBA in the SB after main vessel (MV) drug-eluting stent (DES) implantation in true CBLs.
- To evaluate the impact of DCBs on key clinical outcomes and angiographic parameters.
Main Methods:
- A meta-analysis of six studies involving 1982 patients was conducted.
- Outcomes analyzed included myocardial infarction (MI), target lesion revascularisation (TLR), cardiac death, and late lumen loss (LLL) up to one year.
- Comparison was made between DCB use in the SB and standard POBA.
Main Results:
- DCB use in the SB significantly reduced MI rates (OR 0.38) and TLR rates (OR 0.45) compared to POBA.
- A significant reduction in SB late lumen loss (Mean difference -0.22mm) was observed with DCBs.
- No significant difference in cardiac death rates was found between the groups.
Conclusions:
- DCBs in the SB are superior to POBA for reducing MI, TLR, and LLL after DES implantation in true CBLs.
- Further large, randomized trials are necessary to confirm the role of DCBs in CBL treatment.
Abstract:
Background/Objectives: Coronary bifurcation lesions (CBLs) are common, and the treatments remain nuanced. Side branch (SB) patency is a key determinant of clinical success in CBL intervention. In this paper, data exploring the routine use of drug-coated balloons (DCBs) in the SB is presented as an alternative to standard plain old balloon angioplasty (POBA). Methods: A meta-analysis was performed comparing DCBs in the SB to POBA after drug-eluting stent (DES) implantation in the main vessel (MV) of a true CBL. Outcomes including myocardial infarction (MI), target lesion revascularisation (TLR), cardiac death, and late lumen loss (LLL) up to 1 year post-procedure are reported. Results: Six studies comprising of 1982 patients were included in the analyses. Patients were predominantly male, and the mean age was >60 years. Four studies included patients with acute coronary syndrome. The primary outcomes were a statistically significant reduction in MI rate (OR 0.38, 95% CI 0.19-0.76, p = 0.006), and in the TLR rate (OR 0.45, 95% CI 0.23-0.87, p = 0.02) in the DCB group compared to the control. There was no significant difference in cardiac death. Furthermore, there was a significant reduction in SB LLL in the DCB group (Mean difference -0.22mm, 95% CI -0.33--0.11mm, p = 0.0001). Conclusions: Following DES implantation in the MV of a true CBL, this analysis demonstrated that DCBs in the SB is superior to POBA in reducing MI, TLR, and LLL of the SB. Large, randomized trials are required to consolidate the role of DCB in the treatment of CBL.
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