Drug‐Coated Balloons Versus Drug‐Eluting Stents for De Novo Ostial Left Circumflex Lesions: The International Multicenter DCB‐CIRCO Registry

Background Percutaneous coronary intervention (PCI) with drug‐eluting stents (DES) on ostial left circumflex (oLCx) is associated with a high rate of adverse events. Aims This study aims to compare drug‐coated balloons (DCB) and DES in the treatment of oLCx lesions. Methods Consecutive patients undergoing DCB‐PCI of de novo oLCx lesions (isolated or in the context of a distal left main bifurcation) in eight international centers from 2018 to 2023 were retrospectively enrolled and compared with a historical cohort of patients who received PCI with DES. The primary endpoint was the 2‐year incidence of target lesion failure (TLF), a composite of target lesion revascularization (TLR), target vessel‐myocardial infarction and cardiac death, at time‐to‐first event analysis. Propensity‐score matching was adopted to adjust for clinical and angiographic confounders. Results A total of 152 patients were included in the DCB group and 351 patients in the DES group. Patients in the DES group had more multivessel disease (94.6% vs. 82.7%, p < 0.001) but shorter lesions (18.0 [interquartile range, IQR: 15.0−28.0] vs. 25.5 [17.4−40.0] mm, p < 0.001) than those in the DCB group. Fluoroscopy time (20.0 [IQR: 14.0−28.2] vs. 31.0 [21.0−45.5] min, p < 0.001) and amount of contrast used (150 [IQR: 120−220] vs. 200 [140−250] mL, p = 0.006) were significantly lower in DCB‐PCI than DES‐PCI. The 2‐year rate of TLF was similar in the two groups (19.0% in the DCB group vs. 19.8% in the DES group, hazard ratio [HR]: 1.05, 95% confidence interval [CI] 0.64−1.75). This result remained consistent in the 126 pairs of patients obtained after propensity score matching. Conclusions In a multinational observational retrospective real‐world study including patients undergoing PCI on oLCx, no difference in TLF rate was detected between PCI with DCB and PCI with DES at a midterm follow‐up.