Cardiovascular diagnosis and therapy · 2026
Clinical outcomes of drug-coated balloons vs. drug-eluting stents for coronary chronic total occlusion: a retrospective cohort study.
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Liu Xianglin, Guo Lei, Lv Haichen
Аннотация
BACKGROUND: Drug-coated balloons (DCBs) have emerged as a promising treatment option for chronic total occlusion (CTO). However, direct comparisons of standalone DCB versus drug-eluting stents (DESs) are scarce, and evidence to guide device selection based on vessel anatomy or patient comorbidities is limited. This study aimed to compare the 12-month clinical outcomes between DCB and DES in CTO patients, with emphasis on vessel size and heart failure history.
METHODS: This study retrospectively analyzed 445 patients who underwent CTO-percutaneous coronary intervention (PCI) at the First Affiliated Hospital of Dalian Medical University from March 31, 2020 to March 31, 2023. The primary endpoint was major adverse cardiovascular events (MACEs), including cardiac death, myocardial infarction, target lesion revascularization, target vessel revascularization, and repeat revascularization at 12 months post-procedure. Secondary endpoints included all-cause mortality, recurrent heart failure, new-onset heart failure, and recurrent angina within the 12-month follow-up period. Multivariate Cox proportional hazards regression and subgroup analyses were conducted to compare the incidence of MACE between the two groups.
RESULTS: Among these patients, 163 were treated with DCB and 282 with DES. No significant differences were observed between the two groups in terms of MACE [hazard ratio (HR) 1.37; 95% confidence interval (CI): 0.82-2.26; P=0.21], all-cause mortality (HR 0.68; 95% CI: 0.14-3.13; P=0.62), new-onset heart failure (HR 0.80; 95% CI: 0.08-7.80; P=0.84), or recurrent angina (HR 1.03; 95% CI: 0.66-1.61; P=0.88) during follow-up. However, heart failure recurrence was significantly higher in the DCB group compared to the DES group (HR 0.08; 95% CI: 0.01-0.52; P=0.007). Subgroup analysis indicated a significant interaction (P for interaction =0.008) between treatment strategy (DCB/DES) and vessel size (≤2.75 vs. >2.75 mm). In patients with large-vessel CTO (>2.75 mm), the DCB group had a significantly lower incidence of MACE compared to the DES group (HR 3.46; 95% CI: 1.22-9.78; P=0.02).
CONCLUSIONS: DCB angioplasty is safe and effective for treating CTO, demonstrating comparable clinical outcomes at 12 months to DES implantation. Patients with large-vessel CTO (>2.75 mm) who received DCB following optimal lesion preparation might experience improved prognoses. However, DES might be preferred for CTO patients with heart failure.
METHODS: This study retrospectively analyzed 445 patients who underwent CTO-percutaneous coronary intervention (PCI) at the First Affiliated Hospital of Dalian Medical University from March 31, 2020 to March 31, 2023. The primary endpoint was major adverse cardiovascular events (MACEs), including cardiac death, myocardial infarction, target lesion revascularization, target vessel revascularization, and repeat revascularization at 12 months post-procedure. Secondary endpoints included all-cause mortality, recurrent heart failure, new-onset heart failure, and recurrent angina within the 12-month follow-up period. Multivariate Cox proportional hazards regression and subgroup analyses were conducted to compare the incidence of MACE between the two groups.
RESULTS: Among these patients, 163 were treated with DCB and 282 with DES. No significant differences were observed between the two groups in terms of MACE [hazard ratio (HR) 1.37; 95% confidence interval (CI): 0.82-2.26; P=0.21], all-cause mortality (HR 0.68; 95% CI: 0.14-3.13; P=0.62), new-onset heart failure (HR 0.80; 95% CI: 0.08-7.80; P=0.84), or recurrent angina (HR 1.03; 95% CI: 0.66-1.61; P=0.88) during follow-up. However, heart failure recurrence was significantly higher in the DCB group compared to the DES group (HR 0.08; 95% CI: 0.01-0.52; P=0.007). Subgroup analysis indicated a significant interaction (P for interaction =0.008) between treatment strategy (DCB/DES) and vessel size (≤2.75 vs. >2.75 mm). In patients with large-vessel CTO (>2.75 mm), the DCB group had a significantly lower incidence of MACE compared to the DES group (HR 3.46; 95% CI: 1.22-9.78; P=0.02).
CONCLUSIONS: DCB angioplasty is safe and effective for treating CTO, demonstrating comparable clinical outcomes at 12 months to DES implantation. Patients with large-vessel CTO (>2.75 mm) who received DCB following optimal lesion preparation might experience improved prognoses. However, DES might be preferred for CTO patients with heart failure.