Long-term outcomes of drug-coated balloons in patients with diffuse coronary lesions

Xinyue Yang; Wenjie Lu; Liang Pan; Zhanying Han; Sancong Pan; Xi Wang; Yongjian Zhu; Yingguang Shan; Meng Peng; Peng Qin; Peisheng Zhang; Xiaofei Qin; Guoju Sun; Zhongsheng Qin; Jianzeng Dong; Chunguang Qiu

doi:10.3389/fcvm.2022.935263

Long-term outcomes of drug-coated balloons in patients with diffuse coronary lesions

Front Cardiovasc Med. 2022 Sep 23:9:935263. doi: 10.3389/fcvm.2022.935263. eCollection 2022.

Authors

Affiliations

¹ Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
² Department of Cardiovascular Medicine, Jincheng People's Hospital, Jincheng, China.
³ Department of Geriatric Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
⁴ Department of Cardiology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

Abstract

Background: Drug-coated balloons (DCB), alone or in combination with drug-eluting stents (DES), may be used to treat diffuse coronary lesions. We aimed to explore the efficacy and safety of DCB in patients with diffuse coronary lesions.

Methods: Consecutive patients with diffuse coronary lesions (lesion length > 25 mm) who underwent DCB and/or DES between January 2015 and December 2019 were included in this prospective, observational, multicenter study. The DCB group included 355 patients (360 lesions), of which 142 patients (143 lesions, 39.7%) received the DCB-only strategy and 213 patients (217 lesions, 60.3%) received the hybrid strategy (DCB combined with DES). The DES group included 672 patients (831 lesions) treated with DES alone. Target lesion revascularization (TLR) during 3-year follow-up was the primary outcome of interest. The secondary outcome was major adverse cardiac events (MACE), defined as a composite of all-cause death, non-fatal myocardial infarction, and target vessel revascularization.

Results: The two groups had comparable baseline clinical and lesion characteristics. Lesion length was similar (43.52 ± 16.46 mm vs. 44.87 ± 15.80 mm, P = 0.181), but the stent length in the DCB group was significantly shorter (24.02 ± 23.62 mm vs. 51.89 ± 15.81 mm, P < 0.001). Ten lesions (2.8%) in the DCB group received bailout stents. Over 3 years of follow-up, no significant difference in TLR incidence between the groups (7.3 vs. 8.3%, log-rank P = 0.636) was observed. Incidence of MACE also did not differ significantly (11.3 vs. 13.7%, log-rank P = 0.324). No thrombosis events occurred in the DCB group, while four patients (0.6%) in the DES group experienced stent thrombosis (log-rank P = 0.193). Moreover, similar TLR and MACE rates were observed between DCB-only and hybrid strategies (TLR: 6.4 vs. 8.0%, log-rank P = 0.651; MACE: 11.4 vs. 11.2%, log-rank P = 0.884).

Conclusion: Long-term outcomes show that the efficacy and safety of the DCB strategy (DCB alone or combined with DES) are similar to those of DES alone in diffuse coronary lesions. These findings suggest that this strategy is a promising alternative for select patients with diffuse coronary lesions.

Keywords: coronary heart disease; diffuse coronary lesion; drug-coated balloon; drug-eluting stent; percutaneous coronary intervention.