Drug-Coated Balloon-Based Versus Drug-Eluting Stent-Only Treatment for Single De Novo Diffuse Coronary Lesions

초록

BACKGROUND Data on drug-coated balloons (DCB) treatment in the context of de novo diffuse coronary artery disease (CAD) are limited. This study aimed to investigate the clinical impact of DCB-based percutaneous coronary intervention (PCI) in patients with de novo diffuse long CAD. METHODS A total of 623 patients with single de novo diffuse CAD (>30 mm) were retrospectively included. These patients underwent PCI exclusively for the target lesion and were successfully treated with DCB-based PCI. These patients were compared to 623 propensity-matched patients who underwent conventional PCI with second-generation DES for a 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 was significantly lower in the DCB-based group than in the DES-only group (4.6% vs. 14.6%; hazard ratio, 0.29; 95% confidence interval, 0.18–0.47; P<0.001). Rates of target vessel revascularization (3.1% vs. 9.7%, P<0.001) and major bleeding events (0.8% vs. 2.7%, P=0.008) 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. CONCLUSION In patients with de novo diffuse CAD, the DCB-based PCI was associated with a significant reduction in MACE compared to DES-only PCI.