Utilisation patterns and exploratory short-term outcomes of drug-coated balloon versus drug-eluting stent in percutaneous coronary intervention: a single-centre observational cohort study

Background Drug-coated balloons (DCBs) are an established alternative to drug-eluting stents (DESs) for selected coronary lesions, offering the potential advantages of a stent-free strategy while avoiding permanent metallic implantation. This study compared real-world utilisation patterns, clinical outcomes, and patient-reported outcomes following percutaneous coronary intervention (PCI) with DCBs and DESs. Methods This single-centre retrospective cohort study with prospective follow-up included 214 consecutive patients who underwent PCI with either a DCB ( n = 64) or DES ( n = 150) between January 2023 and March 2026. Baseline demographic, angiographic, procedural, and clinical characteristics were compared. Patient-reported outcomes were assessed at follow-up using a questionnaire adapted from the domains of the Seattle Angina Questionnaire. Multivariable logistic regression was performed to identify independent factors associated with DCB utilisation. Results The study included 214 patients (mean age 56.55 ± 11.49 years), of whom 72.9% were male. Clinical presentation differed significantly between groups ( p = 0.042), the ST-elevation myocardial infarction (STEMI) group more frequently underwent DES (46.0% vs. 29.7%), whereas non-ST-elevation myocardial infarction (NSTEMI) (37.5% vs. 30.7%) and Unstable Angina​ (UA) (15.6% vs. 6.0%) were more common in the DCB group. DCBs were preferentially used in patients with previous coronary revascularization, ISR, small-vessel disease and elective PCI, whereas DESs were more commonly used for acute PCI, total occlusive lesions, and lesions with calcification or thrombus (all p < 0.05). Previous coronary revascularization was associated with increased odds of DCB use, while acute PCI was associated with reduced odds of DCB use compared with elective PCI. No significant differences were observed between groups in mortality at 1, 3, or 6 months, other early clinical outcomes, or patient-reported outcomes. Conclusions DCBs were preferentially used in specific clinical and anatomical settings while demonstrating low observed rates of short-term clinical events and no statistically significant between-group differences in patient-reported outcomes. Despite differences in lesion complexity and treatment selection, no significant differences in early outcomes were observed compared with DES. These findings describe contemporary real-world DCB utilisation in a Sri Lankan PCI centre and provide a basis for further multicentre evaluation.