Procedural Predictors of Optimal Angiographic Lesion Outcomes After Drug-Coated Balloon Treatment for De Novo Coronary Artery Disease

초록

Background Drug-coated balloons (DCBs) are emerging for treating de novo coronary artery disease (CAD), but procedural optimization remains uncertain. This study investigated factors predicting optimal angiographic outcomes after DCB treatment. Methods A total of 317 patients who underwent DCB-based treatment for de novo CAD and completed angiographic follow-up were enrolled: OR (optimal result: diameter stenosis <20% at follow-up; n = 224; 358 lesions) and non-OR (nonoptimal result: n = 84; 93 lesions) groups. Results Baseline characteristics were similar, except OR lesions had a larger reference vessel diameter. Specialty balloons were more frequently used in OR lesions (P = 0.025), with greater maximal balloon diameter and balloon-to-artery (BA) ratio compared with non-OR lesions (P < 0.001 and P = 0.008), indicating differences in lesion preparation techniques. At a median 8-month follow-up, the OR group showed a larger minimal luminal diameter (MLD) and lower late lumen loss, with potential for positive vessel remodeling. In multivariate analysis, post-DCB MLD (per 0.1 mm increase; odds ratio: 1.17; P < 0.001) and BA ratio (per 0.1 increase; odds ratio: 1.43; P = 0.002) were independent predictors for optimal outcomes. Thresholds for favorable angiographic outcomes were 1.95 mm for post-DCB MLD and 1.13 for BA ratio (Figure 1). Conclusions Notable procedural differences were observed between OR and non-OR lesions, particularly in lesion preparation. Achieving greater post-DCB MLD through larger ballooning is crucial for favorable outcomes, underscoring the need for refining procedural strategies for effective DCB treatment.