Abstract
Background The revascularization of small vessels using drug-eluting stents remains challenging. The use of the drug-coated balloon is an attractive therapeutic strategy in de novo lesions in small coronary vessels, particularly in the diabetic group. This study aimed to assess the outcomes of DCB-only angioplasty in small vessel disease. Methods A total of 1198 patients with small vessel disease treated with DCB-only strategy were followed. Patients were divided into the diabetic and nondiabetic groups. Clinical and angiographical follow-up were organized at 12 months. The primary endpoints were target lesion failure and secondary major adverse cardiac events. Results There was a significantly higher rate of target lesion failure among diabetic patients compared to nondiabetic [17 (3.9%) vs. 11 (1.4%), P=0.006], taken separately, the rate of target lesion revascularization significantly differed between groups with a higher rate observed in the diabetic group [9 (2%) vs. 4 (0.5%), P=0.014]. Diabetes mellitus remained an independent predictor for TLF (HR: 2.712, CI: 1.254–5.864, P=0.011) and target lesion revascularization (HR: 3.698, CI: 1.112–12.298, P=0.033) after adjustment. However, no significant differences were observed between groups regarding the target vessel myocardial infarction (0.6% vs. 0.1%, P=0.110) and MACE [19 (4.4%) vs. 21 (2.7%), P=0.120]. Conclusion Drug-coated balloon-only treatment achieved lower incidence rates of TLF and MACE. Diabetes is an independent predictor for target lesion failure and target lesion revascularization at one year following DCB treatment in small coronary vessels. We observed no significant differences between groups regarding MACE in one year.
Highlights
Small vessel coronary disease is an independent predictor for poor outcomes after the percutaneous coronary intervention (PCI) and accounts each year for 30 to 50% of all-comers coronary intervention procedures worldwide [1,2,3,4]. e best treatment strategy for small vessel coronary disease remains a real challenge [5]
Small vessel disease (SVD) poses concrete limitations to the use of drug-eluting stents (DES); the implantation of DES in small vessels is confronted with higher rates of stent failure, restenosis, and repeat revascularization consecutive to the late lumen loss (LLL) [3,4,5,6,7,8]
Is is partly related to the fact that DES leave permanent metallic struts and polymeric matrix within treated vessels which behave as persistent inflammatory stimulus and hinder the full restoration of vessels endothelial functions and the capacity to increase lumen diameter over time [9, 10]. e accelerated LLL is related to the small vessel’s restricted capability to accommodate to even small neointimal proliferation following stent implantation; that is, for Journal of Interventional Cardiology a given neointimal proliferation, the relative lumen reduction will be more pronounced in the small vessel as compared to big vessel [1, 11,12,13]
Summary
Small vessel coronary disease is an independent predictor for poor outcomes after the percutaneous coronary intervention (PCI) and accounts each year for 30 to 50% of all-comers coronary intervention procedures worldwide [1,2,3,4]. e best treatment strategy for small vessel coronary disease remains a real challenge [5]. Conceived to overcome the drawbacks observed with DES, emerging evidence suggests using drug-coating balloons (DCB) as an interesting alternative treatment strategy in small vessel disease [21,22,23,24,25]. Ere are no available data comparing DCB outcomes in diabetic and nondiabetic patients with SVD to the best of our knowledge. It is not clear whether treatment strategy with DCB in this particular setting will result in the same trend of outcomes as observed when DES are used provided that DCB fulfill therapeutic goals of DES without reproducing its limitations and drawbacks. It is not clear whether treatment strategy with DCB in this particular setting will result in the same trend of outcomes as observed when DES are used provided that DCB fulfill therapeutic goals of DES without reproducing its limitations and drawbacks. erefore, this study aims to assess diabetic and nondiabetic patients’ outcomes after drug-coated balloononly strategy in de novo small vessel coronary disease
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
