Drug-coated balloon-based versus drug-eluting stent-only treatment for single de novo diffuse coronary lesions

초록

OBJECTIVE: There are limited data on drug-coated balloon (DCB) treatment for de novo diffuse coronary artery disease (CAD). This study aimed to evaluate the clinical impact of DCB-based percutaneous coronary intervention (PCI) in patients with de novo diffuse long CAD. METHODS: We retrospectively included 623 patients with single de novo diffuse CAD (&#x2265; 30mm). These patients underwent PCI exclusively for the target lesion and were successfully treated with DCB-based PCI. They were compared with 623 propensity-matched patients who underwent conventional PCI with second-generation drug-eluting stents (DES) for diffuse CAD (DES-only group). The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiac death, myocardial infarction, stent or target lesion thrombosis, target vessel revascularization, and major bleeding at 2 years. RESULTS: In the DCB-based group, 73.7% of patients were treated with DCB alone. The MACE rate was significantly lower in the DCB-based group than in the DES-only group (4.6% vs 14.6%; HR, 0.29; 95%CI, 0.18-0.47; P<.001). Rates of target vessel revascularization (3.1% vs 9.7%; P<.001) and major bleeding events (0.8% vs 2.7%; P=.008) were also lower with DCB-based PCI than with DES-only PCI. In a multivariable model, DCB-based PCI was independently associated with a lower risk of 2-year MACE, target vessel revascularization, and major bleeding. CONCLUSIONS: In patients with de novo diffuse CAD, DCB-based PCI was associated with a significant reduction in MACE compared with DES-only PCI. Copyright © 2025 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

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