Drug‐Coated Balloons in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS‐CTO Registry

Background There is limited information on the use of drug‐coated balloons (DCBs) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Aims To assess the frequency and outcomes of DCB use in CTO PCI. Objective This study evaluated the frequency and outcomes of DCB use in a large, multicenter CTO PCI registry. Methods We analyzed 12,146 patients who underwent 12,157 successful CTO PCIs at 59 centers from 2018 to 2025. Results DCBs were used in 454 patients (3.7%) with increasing frequency over time ( p = 0.020). A DCB‐only strategy was used in 48.4% of the patients and a hybrid strategy combining DCBs and drug‐eluting stents (DES) was used in 51.6% of patients. Patients treated with DCB (both strategies) had low prevalence of comorbidities. Compared with the DES cases, DCB only cases had favorable angiographic characteristics, lower mean J‐CTO (Japanese CTO) score (1.83 ± 1.03 vs. 2.27 ± 1.23; p < 0.001), and similar technical success (96.3% vs. 97.3%; p = 0.640), and in‐hospital major adverse cardiac events (MACE). The hybrid and DCB‐only strategies had comparable technical success and in‐hospital MACE. During a median follow‐up of 323 (170–429) days, DCB only cases had lower MACE than the other strategies (hazard ratio [HR] 0.41, 95% CI 0.17–0.96, p = 0.040). After multivariable adjustment, the association remained significant (HR 0.39, 95% CI 0.16–0.92, p = 0.032). Conclusions DCBs are increasingly being used in CTO PCI. A DCB only strategy was used in less complex lesions and was associated with similar technical success and in‐hospital MACE compared with hybrid or DES strategies. A DCB only strategy was associated with lower long‐term MACE.