Comparison of Drug-Coated Balloons and Drug-Eluting Stents in Primary Percutaneous Coronary Interventions for ST-Segment Elevated Myocardial Infarction: A Systemic Review and Meta-Analysis

Abstract

Background:The most optimal strategy for ST-segment elevation myocardial infarction (STEMI) between drug-eluting stents (DES) and drug-coated balloons (DEB) is still unknown. This meta-analysis aims to compare the short-term outcomes of both methods in patients with STEMI. Methods: We searched PubMed, Web of Science, EMBASE, and the Cochrane Library Databases for eligible studies with publication data from 2015 to Jan 2022. Four trials with 360 patients were included. The study was conducted by following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements. Results: There were no significant differences in major adverse cardiac events between DCB and DES during 6 to 12 months of follow-up (RR 1.38, 95% CI: 0.65 to 2.93; p = 0.41). Similar risks of myocardial infarction (RR 0.48, 95% CI: 0.11 to 2.11, p = 0.33), all causes of death (RR 1.55, 95% CI: 0.32 to 7.62, p = 0.59), and target lesion revascularization (RR 1.29, 95% CI: 0.55 to 3.04, p = 0.55) were observed. The pooled results indicated that DCB was comparable to DES in terms of late lumen loss with a mean difference (MD) of -0.06 mm with significant heterogeneity (95% CI: -0.25 to 0.13, p = 0.54, I 2 = 85%). Subsequent subgroup analysis based on the study design revealed that late lumen loss was significantly lower in the drug-coated balloon group in randomized controlled trials (MD -0.16, 95% CI: -0.26 to -0.05, p = 0.003). Conclusions: Drug-coated balloons were associated with similar risks of MACE compared with drug-eluting stents in the setting of STEMI. However, a larger randomized controlled trial is required to confirm these observations.