Clinical outcomes of intravascular imaging-guided versus angiography-guided drug-coated balloon angioplasty for de novo coronary lesions

초록

Background: The clinical value of intravascular imaging during stand-alone drug-coated balloon (DCB) angioplasty for de novo coronary lesions remains uncertain. We evaluated whether intravascular imaging guidance was associated with better 2-year outcomes than angiography guidance. Methods: This retrospective multicenter registry included 2565 patients treated with a drug-coated balloon-first strategy at five teaching hospitals in Korea. Among 1412 patients with successful stand-alone drug-coated balloon treatment for de novo lesions, 990 were propensity score-matched 1:1 according to intravascular imaging or angiography guidance (495 patients per group). The primary endpoint was 2-year target vessel failure (TVF), defined as cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularization. Quantitative coronary angiography was available in a follow-up subset of 704 lesions. Results: The 2-year incidence of TVF was 4.3% in both groups (hazard ratio: 1.07; 95% confidence interval: 0.57–2.03; P = 0.827). Intravascular imaging guidance was associated with more intensive lesion preparation, including greater use of specialty balloons, larger and longer DCBs. In the quantitative coronary angiography subset, acute lumen gain was greater with intravascular imaging guidance (1.3 ± 0.5 mm vs. 1.2 ± 0.5 mm, P = 0.001), whereas late lumen loss was similar between groups (0.1 ± 0.5 mm vs. 0.1 ± 0.4 mm, P = 0.741). Conclusions: In patients undergoing successful stand-alone drug-coated balloon angioplasty for de novo coronary lesions, intravascular imaging guidance was associated with more intensive lesion preparation and greater acute lumen gain, but not with a statistically significant reduction in 2-year TVF. © 2026 Published by Elsevier B.V.

키워드