Meta-analysis of the effects of drug-coated balloons among patients with small-vessel coronary artery disease

Yang, Jing-qi; Peng, Jinhua; Xu, Ting; Liu, Liyun; Tu, Jiehong; Li, Shunhui; Chen, Hui

doi:10.1097/md.0000000000015797

Cited by 5 publications

(2 citation statements)

References 20 publications

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“…Our results are in line with recent meta-analyses focusing on this important issue ( 59 , 75 , 77 , 91 – 93 ). The conflicting results of former studies can be at least partly attributed to differences in the definition of small vessels, devices implanted, implantation technique, use of pharmacological therapies and outcomes evaluated, and small sample sizes ( 87 ).…”

Section: Discussionsupporting

confidence: 93%

Drug-coated balloon: an effective alternative to stent strategy in small-vessel coronary artery disease—a meta-analysis

Felbel,

Bozic,

Mayer

et al. 2023

Front. Cardiovasc. Med.

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BackgroundSmall-vessel coronary artery disease (CAD) is frequently observed in coronary angiography and linked to a higher risk of lesion failure and restenosis. Currently, treatment of small vessels is not standardized while having drug-eluting stents (DES) or drug-coated balloons (DCBs) as possible strategies. We aimed to conduct a meta-analytic approach to assess the effectiveness of treatment strategies and outcomes for small-vessel CAD.MethodsComprehensive literature search was conducted using PubMed, Embase, MEDLINE, and Cochrane Library databases to identify studies reporting treatment strategies of small-vessel CAD with a reference diameter of ≤3.0 mm. Target lesion revascularization (TLR), target lesion thrombosis, all-cause death, myocardial infarction (MI), and major adverse cardiac events (MACE) were defined as clinical outcomes. Outcomes from single-arm and randomized studies based on measures by means of their corresponding 95% confidence intervals (CI) were compared using a meta-analytic approach. Statistical significance was assumed if CIs did not overlap.ResultsThirty-seven eligible studies with a total of 31,835 patients with small-vessel CAD were included in the present analysis. Among those, 28,147 patients were treated with DES (24 studies) and 3,299 patients with DCB (18 studies). Common baseline characteristics were equally distributed in the different studies. TLR rate was 4% in both treatment strategies [0.04; 95% CI 0.03–0.05 (DES) vs. 0.03–0.07 (DCB)]. MI occurred in 3% of patients receiving DES and in 2% treated with DCB [0.03 (0.02–0.04) vs. 0.02 (0.01–0.03)]. All-cause mortality was 3% in the DES group [0.03 (0.02–0.05)] compared with 1% in the DCB group [0.01 (0.00–0.03)]. Approximately 9% of patients with DES developed MACE vs. 4% of patients with DCB [0.09 (0.07–0.10) vs. 0.04 (0.02–0.08)]. Meta-regression analysis did not show a significant impact of reference vessel diameter on outcomes.ConclusionThis large meta-analytic approach demonstrates similar clinical and angiographic results between treatment strategies with DES and DCB in small-vessel CAD. Therefore, DES may be waived in small coronary arteries when PCI is performed with DCB.

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Section: Discussionsupporting

confidence: 93%

Drug-coated balloon: an effective alternative to stent strategy in small-vessel coronary artery disease—a meta-analysis

Felbel,

Bozic,

Mayer

et al. 2023

Front. Cardiovasc. Med.

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“…DCB PCI without stenting in de novo coronary artery disease is becoming more common worldwide, with multiple published registries attesting to its safety 17‐19 . These are, however, cases done by experts who are able to discern whether a ballooned artery can be left unstented, especially when there are associated vascular dissections.…”

Section: Discussionmentioning

confidence: 99%

Three‐year outcome with drug‐coated balloon percutaneous coronary intervention in coronary Takayasu arteritis: A case review

Chiew

Lim

2020

Cathet Cardio Intervent

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We describe the first long‐term follow‐up of a young patient with active Takayasu arteritis who presented with an acute coronary syndrome, treated endovascularly with percutaneous coronary intervention without stenting. A drug‐coated balloon was used with high‐resolution coronary imaging guidance in the form of optical coherence tomography on a critical ostial left anterior descending coronary artery lesion. A repeat procedure was undertaken after 4 months confirming a durable coronary angioplasty result and the patient remained symptom‐free beyond 3 years. Coronary stenting in this population is associated with early and aggressive stent failure. Hence, this is an innovative approach. We believe that the stent, regardless of whether it is first, second or subsequent generation, leaves a permanent foreign body within the vasculature that becomes the seed for inflammatory reactions, resulting in recurrent in‐stent restenotic fibrosis irrespective of concurrent immunotherapy or the degree of disease activity.

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Benefits with drug-coated balloon as compared to a conventional revascularization strategy for the treatment of coronary and non-coronary arterial disease: a comprehensive meta-analysis of 45 randomized trials

Verdoia

Negro

Kedhi

et al. 2021

Vascular Pharmacology

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Meta-analysis of the effects of drug-coated balloons among patients with small-vessel coronary artery disease

Cited by 5 publications

References 20 publications

Drug-coated balloon: an effective alternative to stent strategy in small-vessel coronary artery disease—a meta-analysis

Drug-coated balloon: an effective alternative to stent strategy in small-vessel coronary artery disease—a meta-analysis

Three‐year outcome with drug‐coated balloon percutaneous coronary intervention in coronary Takayasu arteritis: A case review

Benefits with drug-coated balloon as compared to a conventional revascularization strategy for the treatment of coronary and non-coronary arterial disease: a comprehensive meta-analysis of 45 randomized trials

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