Key result
DCB-based PCI linked to ~67% lower 3-year MACCE risk vs. DES in stable angina.
Why the study?
Whether the comparative effectiveness of a DCB-based versus DES-only PCI strategy differs between stable angina and ACS remains uncertain.
Does a drug-coated balloon-based PCI strategy reduce major adverse cardiac and cerebrovascular events compared to a drug-eluting stent-only strategy in patients with stable angina and acute coronary syndrome?
Observational (n=11,522)
Yes
Does a drug-coated balloon-based PCI strategy reduce major adverse cardiac and cerebrovascular events compared to a drug-eluting stent-only strategy in patients with stable angina and acute coronary syndrome?
Hazard Ratio: 0.33 (95% CI 0.22–0.49)
Absolute Event Rate: 3.7% vs 7.9%
Absolute Risk Reduction: 4.2%
p-value: p=<0.001
In routine clinical practice, a DCB-based PCI strategy was associated with significantly lower 3-year rates of MACCE and major bleeding compared to a DES-only strategy in both stable angina and ACS, highlighting its potential as an effective alternative to stenting.
Background: Whether the comparative effectiveness of a drug-coated balloon (DCB)-based versus drug-eluting stent (DES)-only percutaneous coronary intervention (PCI) strategy differs between stable angina (SA) and acute coronary syndrome (ACS) remains uncertain. Methods: In this observational, registry-based study, we analyzed 11,522 patients (4490 with SA and 7032 with ACS) from two multicenter registry sources who had undergone PCI in routine clinical practice; the treatment strategy was not assigned by a study protocol. Within each presentation, the DCB-based and DES-only strategies were compared using propensity-score overlap weighting. Complementary within-strategy analyses compared SA with ACS. The primary outcome was the 3-year rate of major adverse cardiac and cerebrovascular events (MACCE). Results: In both presentations, a DCB-based strategy was associated with a lower 3-year risk of MACCE than a DES-only strategy, with a stronger association in SA (overlap-weighted hazard ratio [HR], 0.33; 95% confidence interval [CI], 0.22–0.49) than in ACS (HR, 0.73; 95% CI, 0.59–0.91; p-for-interaction < 0.001). Within-strategy analyses localized this effect modification to the DCB-based group: SA was associated with a lower risk of MACCE than ACS (HR, 0.47; 95% CI, 0.31–0.69) in the DCB-based group, whereas this gradient was absent in the DES-only group. The incidence of major bleeding was lower with the DCB-based strategy in both presentations. Conclusions: A DCB-based PCI strategy was associated with lower 3-year event rates than a DES-only strategy in both SA and ACS, with the strongest relative association in SA. These observational findings are hypothesis-generating and warrant confirmation in randomized trials.
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Kim et al. (2026) conducted an observational in Stable angina and acute coronary syndrome (n=11,522). Drug-coated balloon (DCB)-based strategy vs. Drug-eluting stent (DES)-only strategy was evaluated on 3-year rate of major adverse cardiac and cerebrovascular events (MACCE) in stable angina (HR 0.33, 95% CI 0.22-0.49, p=<0.001). A drug-coated balloon-based PCI strategy was associated with a lower 3-year risk of MACCE compared to a drug-eluting stent-only strategy in both stable angina (HR 0.33) and acute coronary syndrome (HR 0.73).
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