Drug‐Coated Balloon Versus Drug‐Eluting Stent for Large Coronary Arteries in Patients Presenting With STEMI: A Systematic Review and Meta‐Analysis

ABSTRACT Drug‐coated balloons (DCB) have emerged as a promising stentless strategy in percutaneous coronary intervention, but their role in ST‐elevation myocardial infarction (STEMI) involving large de novo coronary arteries remains uncertain. This systematic review and meta‐analysis evaluated the clinical and angiographic outcomes of DCB compared with drug‐eluting stents (DES) in STEMI patients with large bservational cohorts. The primary outcomes were target lesion revascularization (TLR), major adverse cardiac events (MACE), myocardial infde novo coronary lesions (≥ 2.5 mm). A comprehensive search of PubMed, Scopus, and Web of Science was performed up to July 1, 2025, including randomized controlled trials, non‐randomized trials, and oarction (MI), and cardiac and all‐cause death; angiographic endpoints included minimal lumen diameter (MLD) post‐PCI and at follow‐up, and late lumen loss (LLL). Four studies comprising 1428 patients were included. There were no significant differences between DCB and DES in TLR (RR = 1.16, 95% CI: 0.62–2.17, p = 0.65), MACE (RR = 1.59, 95% CI: 0.64–3.97, p = 0.32), cardiac death (RR = 1.07, 95% CI: 0.55–2.09, p = 0.84), or MI (RR = 1.20, 95% CI: 0.77–1.87, p = 0.42). Post‐PCI MLD was significantly higher with DES (MD = –0.29 mm, 95% CI: –0.39 to –0.20, p < 0.00001), whereas follow‐up MLD did not differ significantly between groups (MD = –0.26 mm, 95% CI: –0.62 to 0.11, p = 0.17). LLL was comparable (MD = 0.02 mm, 95% CI: –0.08 to 0.11, p = 0.73). These findings suggest that DCB represents a safe and effective alternative to DES in STEMI patients with large de novo coronary artery lesions.