Article Impact Level: HIGH Data Quality: STRONG Summary of Circulation: Cardiovascular Interventions, e013232. https://doi.org/10.1161/CIRCINTERVENTIONS.123.013232 Dr. Mauro Gitto et al.
Points
- Drug-coated balloons (DCB) are being used in percutaneous coronary intervention (PCI) for de novo lesions on large vessels, specifically the left anterior descending artery.
- A retrospective study compared the outcomes of patients undergoing DCB-based PCI with those receiving contemporary drug-eluting stents (DES) for left anterior descending artery revascularization.
- The study found that the cumulative 2-year target lesion failure incidence was not significantly different between the DCB and DES groups.
- However, after propensity score matching, the DCB-based treatment was associated with a lower risk for target lesion failure at two years compared to DES-only PCI, primarily due to less target lesion revascularization.
- This suggests that a DCB-based approach for left anterior descending revascularization may reduce stent burden and potentially lower the risk of target lesion failure at midterm follow-up.
Summary
This research paper examines the use of drug-coated balloons (DCB) in percutaneous coronary intervention (PCI) for de novo lesions on large vessels, explicitly focusing on the left anterior descending artery. The study compares the outcomes of patients undergoing DCB-based PCI with those receiving contemporary drug-eluting stents (DES) for left anterior descending artery revascularization. The primary endpoint is target lesion failure at two years, defined as a composite of target lesion revascularization, cardiac death, and target vessel myocardial infarction.
The study retrospectively enrolled 147 consecutive patients who underwent DCB-based treatment on the left anterior descending artery and compared them to 701 patients who received DES-based PCI. The DCB group consisted of patients who underwent DCB-only PCI and those who received a hybrid approach with both DCB and DES. The length of DCB was greater than the stent length in 55.1% of cases. The total treated length was higher in the DCB group, while longer DESs were implanted in the DES cohort. The cumulative 2-year target lesion failure incidence was compared between the two groups.
The study found that the cumulative 2-year target lesion failure incidence was not significantly different between the DCB and DES groups. However, after propensity score matching, the DCB-based treatment was associated with a lower risk for target lesion failure at two years compared to DES-only PCI, primarily driven by less target lesion revascularization. This suggests that a DCB-based treatment approach for left anterior descending revascularization may significantly reduce stent burden and potentially lower the risk of target lesion failure at midterm follow-up.
In conclusion, this study demonstrates that a DCB-based approach for left anterior descending revascularization allows for a reduced stent burden and may potentially limit the risk of target lesion failure at midterm follow-up. These findings contribute to the growing evidence on the use of DCB in PCI and highlight its potential benefits in certain patient populations. Further research is warranted to validate these results and explore the long-term outcomes of DCB-based treatment in large vessel lesions.
Link to the article: https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.123.013232
References Gitto, M., Sticchi, A., Chiarito, M., Novelli, L., Leone, P. P., Mincione, G., Oliva, A., Condello, F., Rossi, M. L., Regazzoli, D., Gasparini, G., Cozzi, O., Stefanini, G. G., Condorelli, G., Reimers, B., Mangieri, A., & Colombo, A. (2023). Drug-Coated Balloon Angioplasty for De Novo Lesions on the Left Anterior Descending Artery. Circulation: Cardiovascular Interventions, e013232. https://doi.org/10.1161/CIRCINTERVENTIONS.123.013232
