1-Year Outcomes of Drug-Coated Balloon Angioplasty Versus Drug-Eluting Stent for Coronary Artery Bypass Graft Lesions

BACKGROUND Graft failure after coronary artery bypass grafting is a common clinical problem associated with adverse cardiovascular outcomes. Although percutaneous coronary intervention (PCI) for bypass graft lesions is frequently performed, the optimal device strategy remains debated. Recently, drug-coated balloon (DCB) has emerged as a stentless alternative. OBJECTIVES This study aimed to compare 1-year clinical outcomes between drug-eluting stent (DES) and DCB-only strategies in patients undergoing PCI for bypass graft lesions. METHODS We analyzed data from the J-PCI OUTCOME (Japanese Percutaneous Coronary Intervention Outcome Registry), a nationwide registry in Japan. Patients who underwent PCI with DES or stentless PCI with DCB for bypass graft lesions between 2017 and 2020 were included. The primary endpoint was major adverse cardiovascular events (MACEs), defined as a composite of all-cause death, acute coronary syndrome, and stroke within 1 year after PCI. Secondary endpoints included individual components of MACE, major bleeding, and planned repeat revascularization. RESULTS Of the 610 PCIs for bypass graft lesions, 184 (30.2%) were stentless PCIs with DCB. One-year MACE rates did not differ significantly between the DES and DCB-only strategies (10.3% vs 8.6%; P = 0.69). No statistically significant differences were observed in the secondary endpoints. After multivariable adjustment, the DCB-only strategy was not associated with a significant difference in MACE risk after PCI compared with the DES-based strategy (adjusted HR: 1.01; 95% CI: 0.58-1.76; P = 0.96). CONCLUSIONS Stentless PCI with DCB was frequently used in patients undergoing PCI for bypass graft lesions in Japan and was not associated with a significant difference in 1-year clinical outcomes compared with contemporary DES-based PCI strategies.