Key result
Drug-coated balloons showed comparable outcomes to drug-eluting stents for major adverse cardiac events in patients with small-vessel CAD (OR 0.92; 95% CI 0.61-1.38; P=0.69).
Why the study?
PCI with DES for small-vessel coronary artery disease carries an increased risk of in-stent restenosis and stent thrombosis, and the application of DCB remains controversial.
Does drug-coated balloon (DCB) reduce major adverse cardiac events compared to drug-eluting stent (DES) in patients with small-vessel coronary artery disease?
Meta-Analysis (n=1,227)
Does drug-coated balloon (DCB) reduce major adverse cardiac events compared to drug-eluting stent (DES) in patients with small-vessel coronary artery disease?
In patients with small-vessel coronary artery disease, drug-coated balloons provide comparable clinical outcomes to drug-eluting stents, with no significant differences in MACE, death, or revascularization.
Supports DCB as alternative to DES in small-vessel CAD; extends Level 1 evidence synthesis for clinical decisions.
Background. Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) of small-vessel coronary artery disease (SVD) is related to an increased risk of in-stent restenosis (ISR) and stent thrombosis (ST). The application of the drug-coated balloon (DCB) for patients with SVD remains controversial. Objectives. Assess the outcomes of DCB in the treatment of SVD compared with DES in patients with SVD. Methods. A meta-analysis of randomized controlled trials (RCTs) published up to June 2020, reporting the outcomes of DCB versus DES in the treatment of SVD, was performed. Results. Four RCTs with 1227 patients were included. The results indicated that DCB was associated with the decreased risk for myocardial infarction (MI) compared with the DES, but the difference showed no significance (OR 0.50, 95% CI 0.24–1.03, <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mi>P</a:mi> <a:mo>=</a:mo> <a:mn>0.06</a:mn> </a:math> ). And, there was no significant difference in death (OR 0.76, 95% CI 0.17–3.43, <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mi>P</c:mi> <c:mo>=</c:mo> <c:mn>0.72</c:mn> </c:math> ), cardiac death (OR 1.92, 95% CI 0.74–4.98, <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mi>P</e:mi> <e:mo>=</e:mo> <e:mn>0.18</e:mn> </e:math> ), target vessel revascularization (TVR) (OR 0.81, 95% CI 0.51–1.28, <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mi>P</g:mi> <g:mo>=</g:mo> <g:mn>0.36</g:mn> </g:math> ), target lesion revascularization (TLR) (OR 1.29, 95% CI 0.66–2.52, <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mi>P</i:mi> <i:mo>=</i:mo> <i:mn>0.46</i:mn> </i:math> ), and major adverse cardiac events (MACE) (OR 0.92, 95% CI 0.61–1.38, <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"> <k:mi>P</k:mi> <k:mo>=</k:mo> <k:mn>0.69</k:mn> </k:math> ) between the DCB group and DES group. Conclusion. Compared with DES, DCB was associated with a decreased risk of MI among patients with SVD, but the difference showed no significance. The application of DCB in SVD is associated with comparable outcomes of death, TVR, and MACE when compared with DES.
No takes yet. Share an insight, caveat, or question.
Wu et al. (2021) conducted a meta-analysis in Small-vessel coronary artery disease (SVD) (n=1,227). Drug-coated balloon (DCB) vs. Drug-eluting stent (DES) was evaluated on Major adverse cardiac events (MACE) (OR 0.92, 95% CI 0.61-1.38, p=0.69). Drug-coated balloons showed comparable outcomes to drug-eluting stents for major adverse cardiac events in patients with small-vessel CAD (OR 0.92; 95% CI 0.61-1.38; P=0.69).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: