DCB-based versus DES-only Strategy for De Novo CAD across CHIP risk categories

초록

BACKGROUND This study evaluated the efficacy and safety of a DCB-based strategy for de novo coronary artery disease across complex and high-risk indicated PCI (CHIP) categories. METHODS Patients treated with DCB alone or in combination with a DES between 2010 and 2023 were retrospectively enrolled (DCB-based group). The comparator group included patients treated exclusively with second-generation DES (DES-only group). Risk stratification was based on the BCIS CHIP score. The primary endpoint was the two-year incidence of major adverse cardiovascular events (MACE): cardiac death, myocardial infarction, target vessel revascularization, target lesion thrombosis, and major bleeding. RESULTS Among 2,022 propensity score-matched pairs, patients were stratified into low (0–2; 1,660 pairs), intermediate (3–4; 304 pairs), and high (> 5; 91 pairs) risk groups. DCB-only treatment was used in 70.8%, with hybrid approaches more frequent in higher-risk patients. Two-year MACE rates increased with CHIP risk in both groups: 5.3%, 6.3%, and 20.0% for DCB-based PCI vs. 10.9%, 16.9%, and 31.2% for DES-only PCI (log-rank p < 0.001 each; Figure). DCB-based PCI was consistently associated with lower MACE risk across all risk levels: low (HR 0.47, 95% CI 0.35–0.62), intermediate (HR 0.35, 95% CI 0.20–0.63), and high (HR 0.49, 95% CI 0.26–0.92) (all p < 0.05), with no significant interaction (p-interaction = 0.819). CONCLUSION DCB-based PCI was associated with significantly lower two-year MACE rates across all CHIP risk categories and may offer a viable alternative to DES-only strategies in selective patients.