Drug-coated balloons showed non-inferior outcomes compared to drug-eluting stents in selected acute coronary syndrome subsets, with a lower risk of major bleeding.
Do drug-coated balloons (DCBs) improve outcomes compared to drug-eluting stents (DES) in selected patients with acute coronary syndrome (ACS)?
Drug-coated balloons represent a reasonable 'leave-nothing-behind' alternative to drug-eluting stents in selected ACS patients, particularly those at high bleeding risk or with complex lesion subsets.
Background: Drug-coated balloons (DCBs) have emerged as a “leave-nothing-behind” strategy in percutaneous coronary intervention (PCI), with potential advantages over drug-eluting stents (DES) in selected patients with acute coronary syndrome (ACS). Methods: We performed a narrative review of randomized controlled trials, registries, and meta-analyses evaluating DCB therapy in ACS, including PEPCAD NSTEMI, REVELATION, BASKET-SMALL 2, AGENT IDE, REC-CAGEFREE I/II, and the ongoing TRANSFORM II trial. Articles were identified through searches of PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane CENTRAL covering January 2005 to February 2026. Results: Across published studies, DCBs have shown outcomes that are non-inferior to those of DES in selected ACS subsets, together with a lower risk of major bleeding attributable to shorter dual antiplatelet therapy (DAPT) requirements. Advances in intravascular imaging and lesion preparation, alongside emerging applications of artificial intelligence (AI) and robotic-assisted PCI, may further improve DCB performance, although evidence specific to DCB use in ACS remains limited for these adjunctive technologies. Conclusions: DCBs are a reasonable alternative to DES in selected patients with ACS, particularly those at high bleeding risk or with lesion subsets in which DES perform less well (small vessels, in-stent restenosis, bifurcations, diffuse disease). Adequately powered randomized trials with long-term follow-up are required before broader recommendations can be made.
Zaghloul et al. (Wed,) conducted a review in Acute coronary syndrome. Drug-coated balloons vs. Drug-eluting stents was evaluated. Drug-coated balloons showed non-inferior outcomes compared to drug-eluting stents in selected acute coronary syndrome subsets, with a lower risk of major bleeding.