Drug Coated Balloon vs. Drug Eluting Stent in Multiculprit Primary Percutaneous Revascularization
DOI:
https://doi.org/10.61919/jhrr.v4i2.849Keywords:
Drug-coated balloon, Drug-eluting stent, Multivessel coronary artery disease, Primary percutaneous coronary intervention, ST-elevation myocardial infarctionAbstract
Background: Patients presenting with ST-elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PCI) frequently face multivessel coronary artery disease (CAD). The optimal interventional approach remains debated.
Objective: To systematically review and analyze the effectiveness and safety of drug-coated balloons (DCB) versus drug-eluting stents (DES) in multiculprit primary PCI through a randomized controlled trial.
Methods: This prospective, single-center, randomized controlled trial included 100 patients with STEMI and multivessel CAD at Lady Reading Hospital Peshawar from April 2023 to March 2024. Patients aged 18 years or older requiring revascularization of two or more culprit lesions were randomized into two groups: one received DCBs and the other DES. Exclusions were based on contraindications to dual antiplatelet therapy, allergies to study drugs, bleeding disorders, or life expectancy under one year.
Results: Each group comprised 50 patients. The prevalence of hypertension (56% in DCB vs. 60% in DES, p=0.68) and diabetes (36% in DCB vs. 40% in DES, p=0.72) was similar. TVR rates were 10% for DCB and 8% for DES (p=0.45). MACE rates were 14% for DCB and 12% for DES (p=0.37).
Conclusion: The study supports the use of DCB as an alternative to DES in specific clinical scenarios, emphasizing the need for tailored treatment decisions based on individual patient and lesion characteristics.
Downloads
References
Ahmad Y, Howard JP, Arnold A, Prasad M, Seligman H, Cook CM, Warisawa T, Shun‐Shun M, Ali Z, Parikh MA, Al‐Lamee R. Complete revascularization by percutaneous coronary intervention for patients with ST‐segment–elevation myocardial infarction and multivessel coronary artery disease: an updated meta‐analysis of randomized trials. Journal of the American Heart Association. 2020 Jun 16;9(12):e015263.
Baumann AA, Mishra A, Worthley MI, Nelson AJ, Psaltis PJ. Management of multivessel coronary artery disease in patients with non-ST-elevation myocardial infarction: a complex path to precision medicine. Therapeutic Advances in Chronic Disease. 2020 Jun;11:2040622320938527.
Developed with the Special Contribution of the European Association for Percutaneous Cardiovascular Interventions (EAPCI), Wijns W, Kolh P, Danchin N, Di Mario C, Falk V, Folliguet T, Garg S, Huber K, James S, Knuuti J. Guidelines on myocardial revascularization: the task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). European heart journal. 2010 Oct 1;31(20):2501-55.
Toth GG, Toth B, Johnson NP, De Vroey F, Di Serafino L, Pyxaras S, Rusinaru D, Di Gioia G, Pellicano M, Barbato E, Van Mieghem C. Revascularization decisions in patients with stable angina and intermediate lesions: results of the international survey on interventional strategy. Circulation: Cardiovascular Interventions. 2014 Dec;7(6):751-9.
Jeger RV, Eccleshall S, Wan Ahmad WA, Ge J, Poerner TC, Shin ES, Alfonso F, Latib A, Ong PJ, Rissanen TT, Saucedo J. Drug-coated balloons for coronary artery disease: third report of the international DCB consensus group. Cardiovascular Interventions. 2020 Jun 22;13(12):1391-402.
Purwowiyoto SL. Coronary Drug-Coated Balloons: Should We Choose a Stentless Approach? DCB: Stentless Approach?. Advances in Cardiac Research. 2023 Jun 13;1(1).
Qamar SU, Spahić L, Benolić L, Zivanovic M, Filipović N. Treatment of peripheral artery disease using injectable biomaterials and drug-coated balloons: safety and efficacy perspective. Pharmaceutics. 2023 Jun 25;15(7):1813.
Merinopoulos I, Gunawardena T, Corballis N, Bhalraam U, Reinhold J, Wickramarachchi U, Maart C, Gilbert T, Richardson P, Sulfi S, Sarev T. Assessment of paclitaxel drug-coated balloon only angioplasty in STEMI. Cardiovascular Interventions. 2023 Apr 10;16(7):771-9.
Chaddad R, El-Mokdad R, Lazar L, Cortese B. DCBs as an adjuvant tool to DES for very complex coronary lesions. Reviews in Cardiovascular Medicine. 2022 Jan 14;23(1):13.
Ang H, Lin J, Huang YY, Chong TT, Cassese S, Joner M, Foin N. Drug-coated balloons: technologies and clinical applications. Current pharmaceutical design. 2018 Feb 1;24(4):381-96.
Shamaki GR, Markson F, Soji-Ayoade D, Agwuegbo CC, Bamgbose MO, Tamunoinemi BM. Peripheral artery disease: a comprehensive updated review. Current Problems in Cardiology. 2022 Nov 1;47(11):101082.
Kleber FX, Rittger H, Bonaventura K, Zeymer U, Wöhrle J, Jeger R, Levenson B, Möbius-Winkler S, Bruch L, Fischer D, Hengstenberg C. Drug-coated balloons for treatment of coronary artery disease: updated recommendations from a consensus group. Clinical Research in Cardiology. 2013 Nov;102:785-97.
Naber CK, Urban P, Ong PJ, Valdes-Chavarri M, Abizaid AA, Pocock SJ, Fabbiocchi F, Dubois C, Copt S, Greene S, Morice MC. Biolimus-A9 polymer-free coated stent in high bleeding risk patients with acute coronary syndrome: a Leaders Free ACS sub-study. European heart journal. 2017 Apr 1;38(13):961-9.
Ussher JR, Greenwell AA, Nguyen MA, Mulvihill EE. Cardiovascular effects of incretin-based therapies: integrating mechanisms with cardiovascular outcome trials. Diabetes. 2022 Feb 1;71(2):173-83.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Anwar Jamal khan , Jabar Ali, Shoaib Iqbal Safi, Wasim Sajjad
This work is licensed under a Creative Commons Attribution 4.0 International License.
