Drug-coated balloon-only PCI resulted in a target vessel revascularization rate of 12.9% versus 5.9% with drug-eluting stents (HR 2.33, 95% CI 0.81–6.74, p=0.118) with no significant difference in long-term outcomes for de novo CTO patients.
Observational (n=170)
No
Does a drug-coated balloon-only strategy improve or maintain comparable target vessel revascularization rates compared to drug-eluting stents in patients undergoing de novo chronic total occlusion PCI?
A drug-coated balloon-only strategy for de novo chronic total occlusion PCI demonstrated long-term efficacy and safety comparable to drug-eluting stents, supporting it as a viable 'leave nothing behind' alternative.
Effect estimate: HR 2.33 (95% CI 0.81–6.74)
Absolute Event Rate: 12.9% vs 5.9%
p-value: p=0.118
Abstract Aim The role of drug-coated balloon (DCB)–only strategy in de novo chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains uncertain. We compared DCB with drug-eluting stent (DES) strategies in patients undergoing CTO angioplasty. Methods We retrospectively analyzed 170 patients with de novo CTO undergoing PCI between 2013 and 2019. Patients were treated with either DCB-only ( n = 85) or DES-only ( n = 85) strategies. The primary endpoint was target vessel revascularization (TVR); secondary endpoints included all-cause mortality, cardiovascular death, target vessel-myocardial infarction (TV-MI), any MI, and a composite of all-cause mortality, MI, and TVR. Median follow-up was 3.67 years. Results TVR occurred in 11 (12.9%) DCB vs. 5 (5.9%) DES patients (HR 2.33, 95% CI 0.81–6.74, p = 0.118). All-cause mortality (7.1% vs. 12.9%; HR 0.56, p = 0.262) and the composite endpoint (21.2% vs. 20.0%; HR 1.15, p = 0.686) did not differ significantly. After adjustment for creatinine, J-CTO score, and vessel diameter, outcomes remained comparable between groups. Creatinine was independently associated with mortality and the composite endpoint. No acute vessel closure or thrombosis occurred within 30 days. During follow-up, no target lesion thrombosis was observed in the DCB group, while one late stent thrombosis (1.2%) occurred in the DES group. Conclusion In this single-center study, a DCB-only strategy for de novo CTO PCI demonstrated long-term efficacy and safety outcomes comparable to DES, supporting DCB as a potential alternative. Graphical Abstract
Natarajan et al. (Thu,) conducted a observational in Adults undergoing percutaneous coronary intervention for de novo coronary chronic total occlusion (n=170). Drug-coated balloon-only percutaneous coronary intervention vs. Drug-eluting stent-only percutaneous coronary intervention was evaluated on Target vessel revascularization (TVR) (HR 2.33, 95% CI 0.81–6.74, p=0.118). Drug-coated balloon-only PCI resulted in a target vessel revascularization rate of 12.9% versus 5.9% with drug-eluting stents (HR 2.33, 95% CI 0.81–6.74, p=0.118) with no significant difference in long-term outcomes for de novo CTO patients.