Drug-Coated Balloon Angioplasty for Femoropopliteal Disease in Diabetic Versus Nondiabetic Patients: A Propensity Score-Matched Analysis.

BACKGROUND

To evaluate drug-coated balloon (DCB) effectiveness for femoropopliteal disease in diabetic versus nondiabetic patients, using propensity score matching.

METHODS

This multicenter registry analyzed 1,779 patients completing 1-year follow-up from 2,356 enrolled patients undergoing DCB treatment. Propensity matching, based on diabetes status, created 597 matched pairs balanced across 23 demographic and lesion characteristics. Primary endpoints included freedom from clinically driven target lesion revascularization and major adverse events at 12 months. Amputation-free survival and freedom from amputation outcomes were specifically analyzed in the chronic limb-threatening ischemia (CLTI) subgroup.

RESULTS

Freedom from clinically driven target lesion revascularization rates were equivalent between diabetic and nondiabetic patients (93.63% vs. 93.84%, P = 0.912), confirming consistent DCB efficacy. Technical success exceeded 98% in both cohorts. Overall survival was 91.68% in diabetic patients versus 95.74% in nondiabetic patients (P = 0.009). In the CLTI subgroup (n = 431; diabetic patients n = 220, nondiabetic patients n = 211), amputation-free survival demonstrated significant risk stratification between diabetic and nondiabetic patients (81.39% vs. 90.19%, P = 0.022, hazard ratio 1.895, 95% confidence interval 1.117-3.214), while freedom from amputation remained excellent without significant difference between diabetic and nondiabetic patients (99.02% vs. 97.92%, P = 0.397, hazard ratio 0.488, 95% confidence interval 0.098-2.418).

CONCLUSION

DCB angioplasty demonstrates comparable technical success and freedom from target lesion revascularization in diabetic and nondiabetic patients. However, diabetic patients exhibited significantly lower overall survival and, in the CLTI subgroup, reduced amputation-free survival, despite similar freedom from amputation rates.