Drug-coated balloons versus drug-eluting stents in acute coronary syndrome: A meta-analysis of randomized controlled trials

A BSTRACT Objectives: Drug-coated balloons (DCB) emerge as a more recent solution to drug-eluting stents (DES) use. Nonetheless, their effectiveness and safety compared to DES in acute coronary syndrome (ACS) remain questionable. Materials and Methods: We performed a systematic search across seven databases and two gray literature sources to select randomized controlled trials (RCTs) comparing DCB and DES in adult patients with ACS. Effect sizes were reported as pooled mean difference (MD) or risk ratio (RR) with 95% confidence intervals (CIs). Results: 673 ACS patients in five RCTs and were included, with a median of 1-year follow-up. DCB significantly reduced late lumen loss (LLL) compared to DES (MD, −0.15 mm; 95% CI, −0.20 to − 0.09; P < 0.00001). No significant differences were observed in other efficacy outcomes: reference vessel diameter (MD, −0.15 mm; P = 0.27), target vessel revascularization (RR, 0.95; P = 0.91), and target lesion revascularization (RR, 1.26; P = 0.76). No significant difference was found between groups, including major adverse cardiovascular events (MACE) (RR, 0.60; P = 0.11), all-cause death (RR, 0.92; P = 0.86), and major bleeding (RR, 1.24; P = 0.77). Subgroup analyses for MACEs, cardiac death, and nonfatal myocardial infarction showed no remarkable differences. Conclusion: In ACS, DCB use reduced LLL compared with DES use. We found no significant differences between both interventions in the remaining efficacy outcomes and safety endpoints.