Key result
DCB-only strategy linked to ~77% higher CD-TLR than DES in large de novo coronary lesions.
Why the study?
The long-term outcomes of drug-coated balloon versus second-generation drug-eluting stent for de novo lesions in large coronary arteries in real-world practice were not well established.
Does a paclitaxel drug-coated balloon only strategy reduce clinically driven target lesion revascularization compared to second-generation drug-eluting stents in patients with large coronary artery de novo lesions?
Cohort (n=2,857)
No
Does a paclitaxel drug-coated balloon only strategy reduce clinically driven target lesion revascularization compared to second-generation drug-eluting stents in patients with large coronary artery de novo lesions?
Answers are grounded in this paper and cite their sources.
For large coronary artery de novo lesions, a DCB-only strategy is associated with a higher risk of target lesion revascularization but a lower risk of major bleeding compared to sDES, making it a feasible option primarily for patients with high bleeding risk.
BACKGROUND: This study aims to evaluate the long-term outcomes of patients with large coronary arteries (LCA, reference vessel diameter more than 3.0 mm) de novo lesions treated by drug-coated balloon (DCB) versus second-generation drug-eluting stent (sDES) in real-world clinical practice. METHODS: Between January 2020 and June 2021, 2857 consecutive patients with equal number of LCA de novo lesions, including 708 lesions treated with paclitaxel DCB-only (DCB-only cohort) and 2149 lesions with sDES-only (sDES-only cohort), were enrolled in this retrospective study. The primary outcome was the clinically driven target lesion revascularization (CD-TLR) rate at two years. After propensity score matching, 708 patients treated with DCB-only and another 704 patients with sDES-only were successfully matched to study adjusted associations between treatment strategy and outcomes. RESULTS: CD-TLR rate was higher in the DCB-only group than sDES-only group (DCB: 5.5%, sDES: 3.1%, P = 0.028). However, lower major bleeding rate was observed in the DCB-only group compared to sDES-only group (0.8% vs. 3.0%, P = 0.003), which benefited from its short duration of antiplatelet therapy. Multivariate logistic regression analysis revealed that hypercholesteremia [odds ratio (OR), 2.516], diabetes (OR, 2.773), severe calcified lesions (OR, 5.184) and residual stenosis>30% (OR, 8.676) were risk predictors (P<0.01) of CD-TLR for DCB-only strategy; meanwhile, diabetes (OR, 3.255) and severe calcified lesions (OR, 2.152) were risk predictors (P<0.01) of CD-TLR for sDES strategy. CONCLUSIONS: DCB-only strategy is feasible for LCA de novo lesions in patients with high bleeding risk, but not suitable in other patients, who should first choose intended stenting strategy especially with unmanageable hypercholesteremia, severe calcified lesions or non-ideal residual stenosis after preprocessing.
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Guo et al. (2024) conducted a cohort in Large coronary artery de novo lesions (n=2,857). Drug-coated balloon (DCB) vs. Second-generation drug-eluting stent (sDES) was evaluated on Clinically driven target lesion revascularization (CD-TLR) at two years (p=0.028). A drug-coated balloon-only strategy resulted in a higher rate of clinically driven target lesion revascularization at two years compared to a second-generation drug-eluting stent (5.5% vs. 3.1%, P=0.028) in patients with large coronary artery de novo lesions.
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