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

Frontiers in Cardiovascular Medicine

Cardiovascular Medicine

Birgid Gonska¹  Sinisa Markovic¹  Tilman Stephan¹  Filip Bozic¹  Johannes Mörike¹  Dominik Felbel¹  Marvin Krohn-Grimberghe¹  Michael Paukovitsch¹  Dominik Buckert¹  Sascha d’Almeida¹  Armin Imhof¹  Wolfgang Rottbauer¹  Benjamin Mayer² 

[1] Department of Cardiology, Angiology, Pneumology and Internal Intensive Care, University of Ulm, Ulm, Germany;Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany;

关键词: drug-eluting stent;    small-vessel coronary artery disease;    drug-eluting balloon;    drug-eluting stents (DES);    drug-eluting stent–drug-coated balloon;   

DOI  :  10.3389/fcvm.2023.1213992

 received in 2023-04-28, accepted in 2023-07-31,  发布年份 2023

来源: Frontiers

【 摘 要 】

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.

【 授权许可】

Unknown   
© 2023 Felbel, Bozic, Mayer, Krohn-Grimberghe, Paukovitsch, d’Almeida, Mörike, Gonska, Imhof, Buckert, Rottbauer, Markovic and Stephan.