Key result
Drug-coated balloons show similar MACE rates to drug-eluting stents in STEMI patients.
Why the study?
The relative efficacy of drug-coated balloons compared to drug-eluting stents in patients with STEMI remains debated due to inconsistent findings across studies.
Does drug-coated balloons reduce major adverse cardiac events compared to drug-eluting stents in patients with ST-Elevation Myocardial Infarction?
Meta-Analysis (n=837)
Does drug-coated balloons reduce major adverse cardiac events compared to drug-eluting stents in patients with ST-Elevation Myocardial Infarction?
Relative Risk: 0.91 (95% CI 0.6–1.37)
Absolute Event Rate: 8.6% vs 10%
p-value: p=0.64
Drug-coated balloons demonstrate comparable efficacy to drug-eluting stents in preventing major adverse cardiovascular events in STEMI patients, supporting their use as a viable 'stent-less' alternative.
Supports DCB as viable stent-less option in STEMI; confirms similar MACE rates to DES in pooled RCTs.
Background Drug-Coated Balloons (DCB) have emerged as a promising "stent-less" and "leave-nothing-behind" strategy in percutaneous coronary interventions, offering a potential alternative to Drug-Eluting Stents (DES). Despite their innovative approach, the relative efficacy of DCB compared to DES in patients with ST-Elevation Myocardial Infarction (STEMI) remains debated. Inconsistent findings from various studies highlight the need to evaluate which method is better and more effective in reducing the risks of major adverse cardiac events (MACE), including nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death. To address this gap, we conducted a meta-analysis comparing the incidence of MACE between DCB and DES in STEMI patients. Methodology This meta-analysis exclusively incorporated randomized controlled trials (RCTs) that assessed the efficacy of DCB versus DES in the specified patient population. A comprehensive systematic search was performed across principal databases. Pooled risk ratios (RR) with 95% confidence intervals (CI) were computed using fixed or random-effects models, depending on the heterogeneity across studies. Results Eight RCTs encompassing a total of 837 patients met the inclusion criteria. The pooled incidence of MACE was 8.6% (n = 36/416) in the DCB cohort compared to 10.0% (n = 42/421) in the DES cohort. The overall pooled risk ratio indicated no statistically significant difference in MACE between DCB and DES (RR = 0.91, 95% CI = 0.60 to 1.37, p = 0.64), with negligible heterogeneity detected among the studies (I² = 0%). Conclusion Our meta-analysis, grounded exclusively in RCT data, reveals no significant difference between DCB and DES angioplasty regarding the prevention of major adverse cardiovascular events, such as all-cause mortality, nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death. Nevertheless, the findings substantiate the role of DCB as a viable alternative to DES in STEMI patients, particularly in specific clinical scenarios. The comparable incidence of MACE affirms the efficacy of DCB, underscoring their distinctive 'stent-less PCI' and 'leave-nothing-behind' advantages. Further research is warranted to ascertain long-term clinical outcomes and cost-effectiveness in this cohort.
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Cervania-Tuazon et al. (2025) conducted a meta-analysis in ST-Elevation Myocardial Infarction (STEMI) (n=837). Drug-Coated Balloons (DCB) vs. Drug-Eluting Stents (DES) was evaluated on Major adverse cardiac events (MACE) (RR 0.91, 95% CI 0.60 to 1.37, p=0.64). Drug-coated balloons showed no significant difference compared to drug-eluting stents for major adverse cardiac events in STEMI patients (RR 0.91; 95% CI 0.60-1.37; p=0.64).
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