Drug coated balloon versus drug eluting stent angioplasty in patients presenting with STEMI: a systematic review and meta-analysis

Introduction Revascularization of patients with ST-elevation myocardial infarction (STEMI) is performed using drug eluting stent (DES). The introduction of devices that facilitate “stent-free” interventions, such as drug coated balloons (DCB), may allow similar performance in thrombotic outcomes, while requiring less intense antiplatelet treatment. As patients presenting with STEMI are considered higher risk, this meta-analysis aims to compare DCB versus DES PCI in this phenotype. Methods A systematic search was performed in three different databases. Following study selection, a meta-analysis was performed. For continuous outcomes, the mean difference (MD) from baseline along with the 95% confidence interval (95%CI) and for dichotomous outcomes, the risk ratio (RR) and the respective 95%CI, were calculated. Results A total of 7 studies and 4,510 patients reported separately event rates in patients with a STEMI diagnosis. In regard to outcomes, no difference was noted in either all-cause (RR: 1.11, 95%CI: 0.87-1.41) or cardiovascular mortality (RR: 1.17, 95%CI: 0.85-1.61). Moreover, patients undergoing DCB revascularization also had similar risk for MACE (RR: 0.85, 95%CI: 0.42-1.72), MI (RR: 0.88, 95%CI: 0.56-1.36), TLR (RR: 0.78, 95%CI: 0.43-1.40) and TVR (RR: 1.10, 95%CI: 0.39-1.37) as patients undergoing DES revascularization. Conclusion In patients presenting with STEMI, the use of DCB results in similar mortality and adverse cardiovascular events to DES. Further trials evaluating differences in presentation, thrombus presence, multivessel disease and pharmacotherapy to comprehensively assess stent-free interventions in this setting.