Clinical Impact of Drug-Coated Balloon–Based Percutaneous Coronary Intervention in Patients With Multivessel Coronary Artery Disease

Shin, Eun‐Seok; Jun, Eun Jung; Kim, Sunwon; Kim, Bitna; Kim, Tae Hyun; Sohn, Chang-Bae; Her, Ae-Young; Park, Yongwhi; Cho, Jung Rae; Jeong, Young‐Hoon; Choi, Byung Joo

doi:10.1016/j.jcin.2022.10.049

Cited by 23 publications

(15 citation statements)

References 17 publications

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“…In a recently published Korean registry, DCB use in patients with multivessel CAD significantly reduced major adverse cardiovascular events at 2 years, defined as the composite of cardiac death, myocardial infarction, stroke, major bleeding, stent thrombosis, and TVR (3.9% versus 11%; P =0.002). 22 The 2-year results of our study confirm favorable clinical outcomes of the DCB-based approach for LAD PCI, with similar TLR and TVR rates as compared with contemporary DES in the overall population and a signal toward less cardiac death and lower TLR risk after PS matching. Of note, the 2-year incidence of TVR was numerically higher in our study (11.6% in the DCB group) than in the report by Shin et al 22 (3.1% at 2 years), which might be explained by (1) longer lesions treated on the LAD, indicating a diffuse atherosclerotic disease on this vessel and (2) the fact that 29% of patients had 3-vessel disease and most of them underwent repeat angiographies for staged non-LAD revascularization, leading to non–clinically-driven TVR.…”

Section: Discussionsupporting

confidence: 72%

“…22 The 2-year results of our study confirm favorable clinical outcomes of the DCB-based approach for LAD PCI, with similar TLR and TVR rates as compared with contemporary DES in the overall population and a signal toward less cardiac death and lower TLR risk after PS matching. Of note, the 2-year incidence of TVR was numerically higher in our study (11.6% in the DCB group) than in the report by Shin et al 22 (3.1% at 2 years), which might be explained by (1) longer lesions treated on the LAD, indicating a diffuse atherosclerotic disease on this vessel and (2) the fact that 29% of patients had 3-vessel disease and most of them underwent repeat angiographies for staged non-LAD revascularization, leading to non–clinically-driven TVR. On the contrary, the observed reduction in cardiac death with DCB was also the main driver of major adverse cardiovascular events reduction in the aforementioned registry and needs further investigation in future studies with longer term follow-up.…”

Section: Discussionsupporting

confidence: 72%

“…On the contrary, the observed reduction in cardiac death with DCB was also the main driver of major adverse cardiovascular events reduction in the aforementioned registry and needs further investigation in future studies with longer term follow-up. 22 This finding might be a play of chance in our study with relatively small sample size, but it suggests that leaving coronary segments unstented does not increase mortality. The reduction in TLR over time is probably the main advantage we should expect from a DCB-based treatment.…”

Section: Discussionmentioning

confidence: 67%

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Drug-Coated Balloon Angioplasty for De Novo Lesions on the Left Anterior Descending Artery

Gitto,

Sticchi,

Chiarito

et al. 2023

Circ: Cardiovascular Interventions

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BACKGROUND: Drug-coated balloons (DCB) are an emerging tool for modern percutaneous coronary intervention (PCI), but evidence on their use for de novo lesions on large vessels is limited. METHODS: Consecutive patients undergoing DCB-based PCI on the left anterior descending artery in 2 Italian centers from 2018 to 2022 were retrospectively enrolled and compared with patients who received left anterior descending PCI with contemporary drug-eluting stents (DES). In-stent restenosis was excluded. The DCB group included both patients undergoing DCB-only PCI and those receiving hybrid PCI with DCB and DES combined. The primary end point was target lesion failure at 2 years, defined as the composite of target lesion revascularization, cardiac death, and target vessel myocardial infarction. RESULTS: We included 147 consecutive patients undergoing DCB-based treatment on the left anterior descending artery and compared them to 701 patients who received conventional PCI with DES. In the DCB group, 43 patients (29.2%) were treated with DCB only and 104 (70.8%) with a hybrid approach; DCB length was greater than stent length in 55.1% of cases. Total treated length was higher in the DCB group (65 [40–82] versus 56 [46–66] mm; P =0.002), while longer DESs were implanted (38 [24–62] versus 56 [46–66] mm; P <0.001) and a higher rate of large vessels were treated (76.2% versus 83.5%; P =0.036) in the DES cohort. The cumulative 2-year target lesion failure incidence was not significantly different between the 2 groups (DCB, 4.1% versus DES, 9.8%; hazard ratio, 0.51 [95% CI, 0.20–1.27]; P =0.15). After a 1:1 propensity score matching resulting in 139 matched pairs, the DCB-based treatment was associated with a lower risk for target lesion failure at 2 years compared with DES-only PCI (hazard ratio, 0.2 [95% CI, 0.07–0.58]; P =0.003), mainly driven by less target lesion revascularization. CONCLUSIONS: A DCB-based treatment approach for left anterior descending revascularization allows a significantly reduced stent burden, thereby potentially limiting target lesion failure risk at midterm follow-up.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 67%

See 1 more Smart Citation

Drug-Coated Balloon Angioplasty for De Novo Lesions on the Left Anterior Descending Artery

Gitto,

Sticchi,

Chiarito

et al. 2023

Circ: Cardiovascular Interventions

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“…In this report, we have demonstrated for the first time that the cost of DCB‐only angioplasty is not different when compared to the cost of DES‐angioplasty. In the context of multivessel PCI, it was recently demonstrated that a DCB‐based treatment approach was associated with significantly lower major adverse cardiovascular events compared to a DES‐only treatment 15 . These findings support, from a cost‐effectiveness perspective, that cost should not be implicated in the decision to choose DCB or DES for de novo coronary artery disease.…”

Section: Discussionmentioning

confidence: 85%

Cost effectiveness analysis of drug coated balloon only angioplasty for de novo coronary artery disease

Merinopoulos,

Gunawardena,

Corballis

et al. 2023

Cathet Cardio Intervent

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AimsWe aimed to perform a cost analysis of drug coated balloon (DCB)‐only angioplasty versus drug eluting stent (DES), for de novo disease of all vessel sizes and all clinical indications.BackgroundDCB angioplasty is an emergent technology for the treatment of coronary artery disease. There is lack of data regarding the cost‐effectiveness of DCB‐only angioplasty for treatment of de novo coronary artery disease as compared with second generation DES.MethodsWe compared total costs of patients treated with DCB or DES for first presentation of ST‐elevation myocardial infarction, non‐ST‐elevation myocardial infarction, or stable angina due to de novo disease between January 1, 2018 and November 15, 2019. We defined total cost as the sum of (1) procedural devices‐cost, (2) procedural staff‐cost, (3) post‐percutaneous coronary intervention hospital stay cost, and (4) antiplatelet regime cost. A cost minimization analysis was performed to compare the costs of DCB and DES.ResultsWe present 1952 all‐comer, consecutive patients; 902 (1064 lesions) treated with DCB and 1050 (1236 lesions) treated with DES for de novo coronary artery disease. The cost per patient was estimated to be £9.02 more expensive in the DCB group (£3153.00 vs. £3143.98). However, the cost per lesion treated was calculated to be £15.51 cheaper in the DCB group (£3007.56 vs. £3023.07). The results were consistent irrespective of duration of long‐term antiplatelet medications.ConclusionWe have compared the cost‐effectiveness of DCB‐only angioplasty to DES‐angioplasty and showed that the per patient and per lesion results were not different and hence cost should not be implicated in the decision to choose DCB or DES.

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“…In fact, approximately half of the lesions treated with DCB achieved LLE 5,7,8 . Furthermore, the lack of foreign materials can lower the risk of thrombosis, reduce the need for long‐term dual antiplatelet therapy (DAPT), and potentially decrease bleeding complications 9,10 . Some randomized control trials showed the noninferiority of DCB for current generation DES in small vessel disease (SVD), 10–12 but the efficacy of DCB for other de novo lesions, such as large vessel disease, severely calcified lesions, and diffuse lesions that we commonly encounter in our clinical practice, has been insufficiently investigated.…”

Section: Introductionmentioning

confidence: 99%

Comprehensive clinical outcomes of drug‐coated balloon treatment for coronary artery disease. Insights from a single‐center experience

Funatsu,

Sato,

Koike

et al. 2024

Cathet Cardio Intervent

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BackgroundSome clinical trials have verified the efficacy and safety of paclitaxel drug‐coated balloon (DCB) for small vessel coronary artery disease. However, nonsmall vessel and calcified lesions received less attention.AimsThis study aimed to investigate the efficacy of DCB treatment for various types of coronary artery lesions, including not only small vessel disease but also nonsmall vessel disease and calcified lesions. In this real‐world clinical practice study, in‐stent restenosis was excluded.MethodsThis study consecutively included 934 patients with 1751 nonstented lesions who received DCB at a cardiovascular center in Kyoto Katsura Hospital in Japan between 2009 and 2012 and 2014 to 2019. This study enrolled and retrospectively analyzed all of the patients. Eligible patients routinely underwent follow‐up angiography at 6–8 months after percutaneous coronary intervention. The primary endpoint includes target lesion revascularization (TLR) during follow‐up. Further, this study calculated the predictor of TLR using multivariate analysis.ResultsThis study included the lesions involving 46.4% of type B2/C, 26.9% with severe calcification, and 6.0% with DCB restenosis. Mean DCB diameter and length were 2.75 ± 0.51 mm and 24.2 ± 9.6 mm, respectively. The median follow‐up duration was 18 months. Follow‐up angiography revealed a TLR rate of 9% and a restenosis rate of 9%. This study identified hemodialysis and current smoking as independent TLR predictors.ConclusionIn routine clinical practice, the effectiveness of DCB was observed consistently across various types of coronary artery disease.

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Clinical Impact of Drug-Coated Balloon–Based Percutaneous Coronary Intervention in Patients With Multivessel Coronary Artery Disease

Cited by 23 publications

References 17 publications

Drug-Coated Balloon Angioplasty for De Novo Lesions on the Left Anterior Descending Artery

Drug-Coated Balloon Angioplasty for De Novo Lesions on the Left Anterior Descending Artery

Cost effectiveness analysis of drug coated balloon only angioplasty for de novo coronary artery disease

Comprehensive clinical outcomes of drug‐coated balloon treatment for coronary artery disease. Insights from a single‐center experience

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