Abstract
Background Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) of small-vessel coronary artery disease (SVD) is related to an increased risk of in-stent restenosis (ISR) and stent thrombosis (ST). The application of the drug-coated balloon (DCB) for patients with SVD remains controversial. Objectives Assess the outcomes of DCB in the treatment of SVD compared with DES in patients with SVD. Methods A meta-analysis of randomized controlled trials (RCTs) published up to June 2020, reporting the outcomes of DCB versus DES in the treatment of SVD, was performed. Results Four RCTs with 1227 patients were included. The results indicated that DCB was associated with the decreased risk for myocardial infarction (MI) compared with the DES, but the difference showed no significance (OR 0.50, 95% CI 0.24–1.03, P=0.06). And, there was no significant difference in death (OR 0.76, 95% CI 0.17–3.43, P=0.72), cardiac death (OR 1.92, 95% CI 0.74–4.98, P=0.18), target vessel revascularization (TVR) (OR 0.81, 95% CI 0.51–1.28, P=0.36), target lesion revascularization (TLR) (OR 1.29, 95% CI 0.66–2.52, P=0.46), and major adverse cardiac events (MACE) (OR 0.92, 95% CI 0.61–1.38, P=0.69) between the DCB group and DES group. Conclusion Compared with DES, DCB was associated with a decreased risk of MI among patients with SVD, but the difference showed no significance. The application of DCB in SVD is associated with comparable outcomes of death, TVR, and MACE when compared with DES.
Highlights
Drug-eluting stents (DES) were normative of care for severe coronary artery disease (CAD)
The efficacy of drug-eluting stents (DES) was limited by stent thrombosis (ST) and in-stent restenosis (ISR) [1]. e drug-coated balloon (DCB) delivers the antiproliferative drug into the vessel wall without implanting a stent. e DCB was a novel therapeutic strategy to overcome the ISR of bare-metal stents (BMS) and DES and recommended in the European Society of Cardiology guidelines [2, 3]
small-vessel coronary artery disease (SVD) is common among the patients who underwent Percutaneous coronary intervention (PCI) [5, 6], which remains an independent predictor of major adverse cardiac events (MACE) [7]
Summary
Drug-eluting stents (DES) were normative of care for severe coronary artery disease (CAD). The application of DCB for patients with SVD remains controversial because different studies have obtained conflicting conclusions. Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) of small-vessel coronary artery disease (SVD) is related to an increased risk of in-stent restenosis (ISR) and stent thrombosis (ST). E results indicated that DCB was associated with the decreased risk for myocardial infarction (MI) compared with the DES, but the difference showed no significance (OR 0.50, 95% CI 0.24–1.03, P 0.06). There was no significant difference in death (OR 0.76, 95% CI 0.17–3.43, P 0.72), cardiac death (OR 1.92, 95% CI 0.74–4.98, P 0.18), target vessel revascularization (TVR) (OR 0.81, 95% CI 0.51–1.28, P 0.36), target lesion revascularization (TLR) (OR 1.29, 95% CI 0.66–2.52, P 0.46), and major adverse cardiac events (MACE) (OR 0.92, 95% CI 0.61–1.38, P 0.69) between the DCB group and DES group. Compared with DES, DCB was associated with a decreased risk of MI among patients with SVD, but the difference showed no significance. Compared with DES, DCB was associated with a decreased risk of MI among patients with SVD, but the difference showed no significance. e application of DCB in SVD is associated with comparable outcomes of death, TVR, and MACE when compared with DES
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