Outcomes with Drug-coated balloons vs. Drug-eluting Stents in Small-Vessel Coronary Artery Disease
Presenter
Michael S Megaly, M.D., FSCAI, Henry Ford Hospital, Bossier City, LA
Michael S Megaly, M.D., FSCAI, Henry Ford Hospital, Bossier City, LA, Kevin G Buda, MD, Hennepin Healthcare, Minneapolis, MN, Marwan Saad, M.D., Ph.D., FSCAI, Brown University, Providence, RI, Mariam Tawadros, MD, Ain Shams University Faculty of Medicine, Cairdo, Egypt, Ayman Elbadawi, MD, The University of Texas Medical Branch, Galveston, TX, Babar B Basir, DO, FSCAI, Henry Ford Health System, Detroit, MI, J. Dawn Abbott, M.D., FSCAI, Rhode Island Hospital, Barrington, RI, Stéphane Rinfret, M.D., FSCAI, Georgia Heart Institute, Atlanta, GA, Khaldoon Alaswad, M.D., FSCAI, Henry Ford Hospital, Detroit, MI and Emmanouil S. Brilakis, MD, PhD, FSCAI, Minneapolis Heart Institute® - Abbott Northwestern Hospital, Minneapolis, MN
Keywords: Drug-coated Balloon (DCB) and Drug-eluting Stent (DES)
Background:
The use of drug-coated balloons (DCBs) in small-vessel coronary artery disease (SVD) remains controversial.
Methods:
We performed a meta-analysis of all randomized controlled trials (RCTs) reporting the outcomes of DCB vs. DES in de-novo SVD. We included a total of 5 RCTs (1,459 patients), with (DCB n=734 and DES n=725).
Results
Over a median follow-up duration of 6 months, DCB was associated with a smaller late lumen loss (LLL) compared with DES (mean difference -0.12 mm (95% confidence interval (CI) [-0.21, -0.03 mm], p=0.01). Over a median follow-up of 12 months, both modalities had a similar risk of major adverse cardiovascular events (MACE) (8.7% vs. 10.2%; odds ratio (OR): 0.94, 95% CI [0.49-1.79], p=084), all-cause mortality (1.17% vs. 2.38%; OR: 0.53, 95% CI [0.16-1.75], p=0.30), target lesion revascularization (TLR) (7.9% vs. 3.9%; OR: 1.26, 95% CI [0.51-3.14], p=0.62), and target vessel revascularization (TVR) (8.2% vs. 7.8%; OR: 1.06, 95% CI [0.40-2.82], p=0.91). DCBs were associated with a lower risk of myocardial infarction (MI) compared with DES (1.55% vs. 3.31%; OR: 0.48, 95% CI [0.23-1.00], p=0.05, I2=0%).
Conclusions
:
PCI of SVD with DCBs is associated with a smaller LLL, a lower risk of MI, and a similar risk of MACE, death, TLR, and TVR compared with DES over one year. DCB appears as an attractive alternative to DES in patients with de-novo SVD, but long-term clinical data beyond are still needed.
