Long-Term Efficacy of Drug-Coated Balloon Treatment for De Novo Left Anterior Descending Artery Disease

초록

Background The effectiveness of drug-coated balloon (DCB)–based percutaneous coronary intervention (PCI) needs further exploration across a wide spectrum of coronary artery disease (CAD). This study investigates the efficacy and safety of DCB-based strategy for de novo left anterior descending artery (LAD) disease. Methods Patients with de novo LAD lesions treated with either DCB alone or a hybrid approach with drug-eluting stents (DES) were retrospectively enrolled from 2010 to 2023 (DCB-based; n = 268). The comparator arm included patients treated with second-generation DES from a Korean multicenter registry (DES-only; n = 4,147). The primary endpoint was 3-year major adverse cardiovascular events (MACE), including cardiac death, myocardial infarction, target vessel revascularization, target lesion thrombosis, and major bleeding. Results Among the 268 patients in the DCB-based group, 206 (76.7%) received DCB only, and 65 (24.3%) underwent a hybrid approach. After propensity score matching of 243 paired subjects, baseline characteristics were well balanced. DCB-based PCI reduced overall stent burden by 86.7% and significantly lowered the risk of MACE up to 3 years compared with those treated with DES-only PCI (4.5% vs 7.6%; HR: 0.50; 95% CI: 0.28-0.90; P = 0.020). The reduced MACE risk was consistently observed across various matching procedures, with the most significant reduction noted in major bleeding. Conclusions The DCB-based approach presents a potential alternative to the DES-only strategy for LAD PCI, significantly reducing 3-year MACE risk and supporting its preferential use in treating de novo CAD.