Long-term outcomes of less drug-eluting stents by the use of drug-coated balloons in de novo coronary chronic total occlusion intervention: A multicenter observational study

Xi Wang; Xinyue Yang; Wenjie Lu; Liang Pan; Zhanying Han; Sancong Pan; Yingguang Shan; Xule Wang; Xiaolin Zheng; Ran Li; Yongjian Zhu; Peng Qin; Qiangwei Shi; Shuai Zhou; Wencai Zhang; Sen Guo; Peisheng Zhang; Xiaofei Qin; Guoju Sun; Zhongsheng Qin; Zhenwen Huang; Chunguang Qiu

doi:10.3389/fcvm.2023.1045859

Long-term outcomes of less drug-eluting stents by the use of drug-coated balloons in de novo coronary chronic total occlusion intervention: A multicenter observational study

Front Cardiovasc Med. 2023 Mar 3:10:1045859. doi: 10.3389/fcvm.2023.1045859. eCollection 2023.

Authors

Xi Wang¹, Xinyue Yang¹, Wenjie Lu¹, Liang Pan¹, Zhanying Han¹, Sancong Pan², Yingguang Shan¹, Xule Wang¹, Xiaolin Zheng¹, Ran Li¹, Yongjian Zhu¹, Peng Qin³, Qiangwei Shi¹, Shuai Zhou¹, Wencai Zhang¹, Sen Guo¹, Peisheng Zhang⁴, Xiaofei Qin¹, Guoju Sun¹, Zhongsheng Qin², Zhenwen Huang¹, Chunguang Qiu¹

Affiliations

¹ Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
² Department of Cardiovascular Medicine, Jincheng People's Hospital, Jincheng, China.
³ Department of Geriatric Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
⁴ Department of Cardiology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

Abstract

Background: Data on drug-coated balloons (DCB) for de novo coronary chronic total occlusion (CTO) are limited. We aimed to investigate the long-term outcomes of substitution of drug-eluting stents (DES) by DCB.

Methods: We compared the outcomes of less DES strategy (DCB alone or combined with DES) and DES-only strategy in treating de novo coronary CTO in this prospective, observational, multicenter study. The primary endpoints were major adverse cardiovascular events (MACE), target vessel revascularization, myocardial infarction, and death during 3-year follow-up. The secondary endpoints were late lumen loss (LLL) and restenosis until 1-year after operation.

Results: Of the 591 eligible patients consecutively enrolled between January 2015 and December 2019, 281 (290 lesions) were treated with DCB (DCB-only or combined with DES) and 310 (319 lesions) with DES only. In the DCB group, 147 (50.7%) lesions were treated using DCB-only, and the bailout stenting rate was relatively low (3.1%). The average stent length per lesion in the DCB group was significantly shorter compared with the DES-only group (21.5 ± 25.5 mm vs. 54.5 ± 26.0 mm, p < 0.001). A total of 112 patients in the DCB group and 71 patients in the DES-only group (38.6% vs. 22.3%, p < 0.001) completed angiographic follow-up until 1-year, and LLL was much less in the DCB group (-0.08 ± 0.65 mm vs. 0.35 ± 0.62 mm, p < 0.001). There were no significant differences in restenosis occurrence between the two groups (20.5% vs. 19.7%, p > 0.999). The Kaplan-Meier estimates of MACE at 3-year (11.8% vs. 12.0%, log-rank p = 0.688) was similar between the groups.

Conclusion: Percutaneous coronary intervention with DCB is a potential "stent-less" therapy for de novo CTO lesions with satisfactory long-term clinical results compared to the DES-only approach.

Keywords: chronic total occlusion; coronary heart disease; drug-coated balloon; drug-eluting stent; percutaneous coronary intervention.