Drug-Coated Balloon Treatment After Lesion Preparation in Selected Acute Coronary Syndrome Lesions: A Dual-Center Real-World Registry

Drug-coated balloon (DCB) PCI can avoid permanent metallic scaffolding in selected acute coronary syndrome (ACS) lesions, but interpretation depends on lesion preparation, procedural selection, and follow-up ascertainment. We analyzed a retrospective dual-center registry of 276 unique patients who underwent one index DCB-treated ACS procedure after operator-judged adequate lesion preparation. Presentations were NSTEMI in 174 patients (63.0%), STEMI in 90 (32.6%), and unstable angina in 12 (4.3%). Paclitaxel-coated DCBs were used in 262 patients (94.9%) and sirolimus/non-paclitaxel DCBs in 14 (5.1%). Thrombus aspiration and GP IIb/IIIa inhibitors were used selectively in 17 (6.2%) and 28 (10.1%) patients, respectively. Bail-out stenting was required in 13 patients (4.7%). Predominantly benign/non-flow-limiting angiographic dissection was recorded in 18 patients (6.5%). A follow-up of at least 365 days or death within 365 days was available for 274 patients (99.3%). Clinically driven TLR occurred in 18 patients (crude 18/274, 6.6%; Kaplan–Meier 365-day estimate, 6.8%; 95% CI, 4.3–10.5), all occurring between 3 and 9 months. All-cause death occurred in 12 patients (Kaplan–Meier estimate, 4.4%; 95% CI, 2.5–7.5). In selected ACS lesions that passed a preparation gate, DCB treatment was associated with feasible procedural results and acceptable 12-month clinically recorded outcomes. The findings do not estimate all-comer DCB eligibility and should not be interpreted in terms of the efficacy of DCBs compared with DESs.