Key result
A strategy of drug-coated balloon after bare-metal stent resulted in a similar rate of uncovered struts at 90 days compared to sirolimus-eluting stents (3.2% vs 3.2%, P=0.64).
Why the study?
DCBs have theoretical advantages over DESs to facilitate stent healing, but whether a DCB strategy after bare-metal stent improves early healing compared to new-generation DES during pPCI was unknown.
Does a drug-coated balloon strategy after bare-metal stenting improve early coronary healing compared to sirolimus-eluting stents in patients undergoing primary PCI for STEMI?
RCT (n=53)
1:1
Does a drug-coated balloon strategy after bare-metal stenting improve early coronary healing compared to sirolimus-eluting stents in patients undergoing primary PCI for STEMI?
Answers are grounded in this paper and cite their sources.
In STEMI patients undergoing primary PCI, a strategy of bare-metal stenting followed by a drug-coated balloon improves early optical coherence tomography-derived healing metrics at 3 months compared to sirolimus-eluting stents.
OBJECTIVES: Drug-coated balloons (DCBs) have theoretical advantages over drug-eluting stents (DESs) to facilitate stent healing. We studied whether, in patients undergoing primary coronary interventions (pPCIs), a strategy of DCB after bare-metal stent improves early healing as determined by optical coherence tomography (OCT) compared with new-generation DES. METHODS: pPCI patients were randomized (1:1) to treatment with new-generation sirolimus-eluting stents (DES group) or DCB-strategy. Vessel healing was assessed by OCT at 90 days. RESULTS: Fifty-three patients were randomized (26 DES vs. 27 DCB). At 90 days, both strategies showed a low rate of uncovered struts (3.2 vs. 3.2%, P = 0.64) and a very high and similar rate of covered and apposed struts (96.6 vs. 96.1%, respectively; P = 0.58). However, DCB group had a significantly lower rate of major coronary evaginations (68 vs. 37%, P = 0.026), and more frequently developed a thin homogeneous neointimal layer (20 vs. 70.4%, P = 0.001) suggesting distinct superior healing at 3 months compared to DES. CONCLUSIONS: In pPCI both, sirolimus-DES and DCB-strategy, provide excellent strut coverage at 3 months. However, DCB ensures more advanced and optimal stent healing compared to sirolimus-DES. Further research is needed to determine whether, in patients undergoing pPCI, DCB offers superior long-term clinical and angiographic outcomes than new-generation DES (NCT03610347).
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García‐Touchard et al. (2021) conducted an RCT in ST segment elevation myocardial infarction (n=53). Drug-coated balloon (DCB) after bare-metal stent vs. New-generation sirolimus-eluting stents (DES) was evaluated on Rate of uncovered struts assessed by optical coherence tomography at 90 days (p=0.64). A strategy of drug-coated balloon after bare-metal stent resulted in a similar rate of uncovered struts at 90 days compared to sirolimus-eluting stents (3.2% vs 3.2%, P=0.64).
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