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Published on: February 18, 2020
Drug-coated balloon-based strategy in real-world coronary bifurcation lesions: A retrospective comparative study
Tomohide Endo1, Kazumasa Saito1, Shuntaro Sakai1
1Department of Cardiology, Hachinohe City Hospital, 3-1-1 Tamukai, Hachinohe-shi, Aomori, 031-0011, Japan.
Background:
Side branch compromise remains a major limitation of percutaneous coronary intervention for coronary bifurcation lesions. Drug-coated balloon (DCB)-based strategies may preserve bifurcation geometry by avoiding permanent metallic scaffolds.
Aims:
To compare side branch-related events between DCB- and drug-eluting stent (DES)-based strategies.
Methods:
We retrospectively analyzed 340 patients with coronary bifurcation lesions treated using either a DCB-based strategy (n = 140) or a DES-based strategy (n = 200). The primary endpoint was any side branch-related event, defined as side branch occlusion or significant flow deterioration. Secondary endpoints included major adverse cardiac events (MACE) at 6 months and 1 year. Propensity score matching was performed.
Results:
The DCB group had more severe calcification and more frequent debulking device use. Side branch rewiring was less frequent in the DCB group (2.3% vs. 23.2%, P < 0.001). Side branch-related events were lower with DCB than DES (3.1% vs. 14.7%, P = 0.001). Side branch occlusion (0.8% vs. 6.2%, P = 0.018) and CK elevation associated with occlusion (0% vs. 5.4%, P = 0.007) were also reduced. MACE was lower at 6 months (0% vs. 5.4%, P = 0.007), but not at 1 year (3.9% vs. 8.5%, P = 0.121). After matching, 129 pairs were generated, with consistent findings.
Conclusions:
A DCB-based strategy was associated with fewer side branch-related events than a DES-based strategy. Avoiding permanent metallic scaffolds may help preserve side branch patency.
