Drug-Coated Balloon-Based Versus Drug-Eluting Stent-Only Treatment for Large Vessel Coronary Artery Disease.

Drug-coated balloon (DCB) treatment has shown outcomes comparable to drug-eluting stent (DES) in small vessel coronary disease. However, evidence for its application in large vessel coronary artery disease (CAD) remains limited. This study evaluated the clinical impact of DCB-based percutaneous coronary intervention (PCI) in patients with large vessel CAD. We retrospectively enrolled 550 consecutive patients with reference vessel diameter ≥ 3.0 mm treated with DCB-based PCI and propensity-matched them 1:1 to 550 patients who underwent conventional PCI with second-generation DES (DES-only group). The primary endpoint was 2-year major adverse cardiac events (MACE), defined as a composite of cardiac death, non-fatal myocardial infarction, definite target lesion thrombosis, and target vessel revascularization (TVR). In the DCB-based group, 390 patients (70.9%) were treated with DCB alone. Total device length was higher in the DCB group (40.0 ± 23.3 vs. 35.4 ± 23.3 mm; p = 0.001), whereas mean implanted stent length was shorter (9.6 ± 18.4 vs. 35.4 ± 23.3 mm; p < 0.001). The cumulative 2-year incidence of MACE was significantly lower after DCB-based PCI than after DES-only PCI (4.3% vs. 9.7%; hazard ratio: 0.43; 95% confidence interval: 0.26 to 0.70; p = 0.001). TVR was also lower in DCB-based PCI (3.4% vs. 7.5%; hazard ratio: 0.45; 95% confidence interval: 0.25 to 0.81; p = 0.008). There was no difference in cardiac death, myocardial infarction, or major bleeding. In patients with large vessel CAD, DCB-based PCI strategy was associated with a significant reduction in MACE compared with DES-only PCI at 2-year follow-up, primarily driven by a lower rate of TVR.