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Tartaglia F, Gitto M, Leone PP, Chiarito M, Calamita G, Mincione G, Gasparini G, Reimers B, Cozzi OF, Rossi ML, Stefanini GG, Regazzoli D, Mangieri A, Colombo A. Validation of complex PCI criteria in drug-coated balloon angioplasty. Clin Res Cardiol 2025:10.1007/s00392-025-02664-x. [PMID: 40387891 DOI: 10.1007/s00392-025-02664-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2025] [Accepted: 04/21/2025] [Indexed: 05/20/2025]
Abstract
BACKGROUND Procedural complexity during percutaneous coronary interventions (PCI) with drug-eluting stent (DES) has been associated with adverse events, especially in case of long and multiple stents implantation. OBJECTIVE This study aims to validate contemporary complex PCI criteria for drug coated balloon (DCB)-based PCI. METHODS Consecutive patients undergoing DCB angioplasty at 2 Italian centers from 2018 to 2023 were retrospectively enrolled. Complex DCB-PCI was defined as the presence of at least 1 of the 6 following features: 3 vessels treated; ≥ 3 lesions treated; ≥ 3 devices (DES or DCB) used; bifurcation treated with 2 devices; total device length (DES + DCB) > 60 mm; CTO as target lesion. The primary endpoint was the 2 year incidence of target lesion failure (TLF), a composite of target lesion revascularization (TLR), target vessel-myocardial infarction and cardiac death, at time-to-first event analysis. RESULTS A total of 1279 patients were included, of whom 642 (50.2%) met complex PCI criteria. The most frequently met criteria was "total device length > 60 mm" (71.6% in the complex PCI group). The proportion of in-stent restenosis (ISR) was 30.8% in the complex DCB-PCI group and 43.8% in the non-complex PCI group (p < 0.001). After adjusting for relevant clinical covariates and for the presence of ISR, patients undergoing complex PCI had a higher incidence of TLF at 2 years as compared to those undergoing non-complex PCI (16.7 vs. 11.4%; adj. hazard ratio 1.73, 95% confidence interval 1.16-2.59, p = 0.007). However, such difference was significant only in the ISR subgroup, while outcomes of complex and non-complex PCI for de novo lesions were similar. CONCLUSIONS In a real-world cohort of patients undergoing DCB angioplasty, complex PCI criteria were frequently met and associated with higher risk of TLF. However, their prognostic impact was limited in patients with de novo coronary lesions treated with DCB.
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Affiliation(s)
- Francesco Tartaglia
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Mauro Gitto
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | | | - Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Gianmaria Calamita
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Gianluca Mincione
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Gabriele Gasparini
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Bernhard Reimers
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Ottavia F Cozzi
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | | | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Damiano Regazzoli
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Antonio Mangieri
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, 20072, Pieve Emanuele, Milan, Italy.
- Department of Cardiovascular Medicine, IRCCS Humanitas Research Hospital, 20089, Rozzano, Milan, Italy.
- EMO-GVM Centro Cuore Columbus, Milan, Italy.
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Fezzi S, Scheller B. Eternal Battle in Multivessel Disease: Is There a Glimmer of Hope for PCI in NSTE-ACS? JACC Cardiovasc Interv 2025; 18:849-852. [PMID: 40240082 DOI: 10.1016/j.jcin.2025.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2025] [Accepted: 03/13/2025] [Indexed: 04/18/2025]
Affiliation(s)
- Simone Fezzi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
| | - Bruno Scheller
- Clinical and Experimental Interventional Cardiology, University of Saarland, Homburg/Saar, Germany
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Her AY, Ahmad WAW, Bang LH, Kiam OT, Nuruddin AA, Hsieh IC, Hwa HH, Yahaya SA, Tang Q, Hsu JC, Qiu C, Qian J, Ali RM, Shin ES. Drug-Coated Balloon-Based Intervention for Coronary Artery Disease: The Second Report of Asia-Pacific Consensus Group. JACC. ASIA 2025:S2772-3747(25)00185-1. [PMID: 40304645 DOI: 10.1016/j.jacasi.2025.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Revised: 02/20/2025] [Accepted: 02/22/2025] [Indexed: 05/02/2025]
Abstract
Drug-coated balloons (DCBs) provide a stent-free alternative, reducing risks like stent thrombosis and in-stent restenosis and the need for prolonged dual antiplatelet therapy. Recent studies show that DCBs can be effective and safe across various coronary artery diseases (CADs) when lesions are adequately prepared. Specifically, all coronary lesions are treated using the provisional approach, where active lesion preparation is followed by DCB or drug-eluting stent treatment, depending on the results. This approach means DCB is considered the default device before initiating intervention, with efforts focused on obtaining adequate lesion preparation. Depending on the result, DCB or drug-eluting stent is selected, which is termed DCB-based percutaneous coronary intervention. Therefore, this second report of the Asia-Pacific Consensus Group provides practical guidelines (DCB-based percutaneous coronary intervention) based on the latest evidence for DCB treatment in CAD and aims to expand its application across various CADs, facilitating its effective use in real-world clinical practice.
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Affiliation(s)
- Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Wan Azman Wan Ahmad
- Division of Cardiology, Department of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Liew Houng Bang
- Cardiology Department and Clinical Research Center, Queen Elizabeth Hospital II, Kota Kinabalu, Malaysia
| | - Ong Tiong Kiam
- Cardiology Department, Sarawak Heart Centre, Kota Samarahan, Malaysia
| | - Amin Ariff Nuruddin
- Cardiology Department, National Heart Institute Malaysia, Kuala Lumpur, Malaysia
| | - I-Chang Hsieh
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | | | - Shaiful Azmi Yahaya
- Cardiology Department, National Heart Institute Malaysia, Kuala Lumpur, Malaysia
| | - Qiang Tang
- Division of Cardiology, Department of Internal Medicine, Beijing University ShouGang Hospital, Beijing, China
| | - Jung-Cheng Hsu
- Department of Cardiology, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - ChunGuang Qiu
- Division of Cardiology, Department of Internal Medicine, The First Affiliated Hospital of ZhengZhou University, ZhengZhou, China
| | - Jie Qian
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rosli Mohd Ali
- Cardiac Vascular Sentral Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
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4
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Her AY, Kim TH, Shin ES, Kim S, Kim B, Kim YH, Choi KH, Cho YK, Lee HJ, Song YB, Nam CW, Gwon HC. Drug-Coated Balloon-Based Treatment of Left Main True Bifurcation Lesion. Catheter Cardiovasc Interv 2025; 105:1024-1031. [PMID: 39840648 DOI: 10.1002/ccd.31416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2024] [Revised: 01/06/2025] [Accepted: 01/09/2025] [Indexed: 01/23/2025]
Abstract
BACKGROUND There is a paucity of data regarding drug-coated balloon (DCB) treatment in the context of left main (LM) true bifurcation lesions. AIMS The aim of this study was to evaluate the safety and efficacy of DCB-based treatment for unprotected LM true bifurcation lesions. METHODS A total of 39 patients with LM true bifurcation lesion (Medina: 1,1,1/0,1,1/1,0,1) who were successfully treated with DCB alone or in combination with drug-eluting stent (DES) were retrospectively enrolled into the DCB-based group. They were compared with 39 propensity-matched patients who were treated with second-generation DES from the COBIS III registry (n = 2648). Major adverse cardiovascular events (MACE) were defined as cardiac death, myocardial infarction, stent or target lesion thrombosis, and target lesion revascularization at the 2-year follow-up. RESULTS Baseline clinical characteristics were similar between the groups, except for the prevalence of in-stent restenosis (ISR) lesions (41.0% in DCB-based group vs. 17.9% in DES-only group, p = 0.047). In the DCB-based group, 59.0% of the patients (n = 23) underwent DCB-only treatment. There were no cases of abrupt vessel closure requiring treatment following DCB application. The MACE were comparable between both groups (12.8% in DCB-based group vs. 17.9% in DES-only group, p = 0.861) after 2 years. CONCLUSIONS In patients with unprotected LM true bifurcation lesions, DCB-based treatment demonstrated comparable clinical outcomes at the 2-year follow-up when compared to DES-only treatment. DCB-based treatment could be considered a safe and effective alternative to DES for carefully selected patients who have achieved satisfactory predilation results (Impact of DCB Treatment in De Novo Coronary Lesion; NCT04619277).
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Affiliation(s)
- Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Tae Hyun Kim
- Department of Cardiology, Ulsan Medical Center, Ulsan, South Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Sunwon Kim
- Department of Cardiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan-si, South Korea
| | - Bitna Kim
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Ki Hong Choi
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, South Korea
| | - Yun-Kyeong Cho
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Hyun-Jong Lee
- Department of Internal Medicine, Sejong General Hospital, Bucheon, South Korea
| | - Young Bin Song
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, South Korea
| | - Chang-Wook Nam
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Hyeon-Cheol Gwon
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, South Korea
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Takahashi T, Watanabe T, Toyoshima M, Katawaki W, Toshima T, Kumagai Y, Yamanaka T, Watanabe M. Prognostic Impact of Chronic Kidney Disease After Percutaneous Coronary Intervention with Drug-Coated Balloons. J Clin Med 2025; 14:2317. [PMID: 40217766 PMCID: PMC11989811 DOI: 10.3390/jcm14072317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2025] [Revised: 03/21/2025] [Accepted: 03/26/2025] [Indexed: 04/14/2025] Open
Abstract
Background: A drug-coated balloon (DCB) is an emerging treatment technology for percutaneous coronary intervention (PCI). However, the prognostic factors of PCI with a DCB remain fully determined. Chronic kidney disease (CKD) is an independent predictor of adverse outcomes in patients with coronary artery disease (CAD) who underwent PCI. The aim of this present study was to clarify the impact of CKD on prognosis in CAD patients who underwent PCI with a DCB. Methods: We enrolled 252 consecutive patients with CAD who underwent PCI with a DCB from 2015 to 2023. The endpoints of this study were composite events including all-cause death, myocardial infarction, target vessel revascularization, stroke, and major bleeding. Results: The prevalence rate of CKD was 48%. Patients with CKD were older and had higher prevalence of hypertension and diabetes mellitus than those without. Kaplan-Meier analysis revealed a significantly higher composite event rate in patients with CKD (log-rank test, p = 0.003). In the multivariate Cox proportional hazards analysis, CKD was independently associated with composite events after adjusting for confounding factors (adjusted hazard ratio 1.985, 95% confidence intervals 1.157-3.406, p = 0.013), mainly driven by all-cause deaths. Conclusions: CKD was associated with unfavorable outcomes in CAD patients who underwent PCI with a DCB.
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Affiliation(s)
- Tetsuya Takahashi
- The Department of Cardiology, Japanese Red Cross Ishinomaki Hospital, Ishinomaki 986-0861, Japan
| | - Tetsu Watanabe
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata 990-9585, Japan
| | - Mashu Toyoshima
- The Department of Cardiology, Japanese Red Cross Ishinomaki Hospital, Ishinomaki 986-0861, Japan
| | - Wataru Katawaki
- The Department of Cardiology, Japanese Red Cross Ishinomaki Hospital, Ishinomaki 986-0861, Japan
| | - Taku Toshima
- The Department of Cardiology, Japanese Red Cross Ishinomaki Hospital, Ishinomaki 986-0861, Japan
| | - Yu Kumagai
- The Department of Cardiology, Japanese Red Cross Ishinomaki Hospital, Ishinomaki 986-0861, Japan
| | - Tamon Yamanaka
- The Department of Cardiology, Japanese Red Cross Ishinomaki Hospital, Ishinomaki 986-0861, Japan
| | - Masafumi Watanabe
- The Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata 990-9585, Japan
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6
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Gitto M, Leone PP, Gioia F, Chiarito M, Latini A, Tartaglia F, Kilic ID, Rossi ML, Regazzoli D, Gasparini G, Cozzi O, Sticchi A, Condorelli G, Reimers B, Stefanini G, Mangieri A, Colombo A. Coronary Artery Dissection in Drug-Coated Balloon Angioplasty: Incidence, Predictors, and Clinical Outcomes. Am J Cardiol 2025; 239:28-35. [PMID: 39667516 DOI: 10.1016/j.amjcard.2024.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Revised: 11/09/2024] [Accepted: 12/05/2024] [Indexed: 12/14/2024]
Abstract
Coronary dissection is a potential occurrence after lesion preparation for percutaneous coronary intervention (PCI). Unlike stents, drug-coated balloons (DCBs) do not allow to cover dissections, thus demanding an assessment of their safety in this setting. This study aimed to evaluate the incidence, predictors, and clinical outcomes of dissections occurring with DCB-based PCI for de novo coronary artery disease. Consecutive patients with de novo coronary artery disease who underwent PCI with intention-to-treat DCB angioplasty, with or without stent implantation, were retrospectively enrolled between 2018 and 2022 at 2 Italian centers. The decision whether to leave a dissection untreated or to proceed with bail-out stenting was based on a combined angiographic evaluation of Thrombolysis In Myocardial Infarction flow, residual minimal lumen diameter, and persistent extraluminal contrast hang-up. The primary end point at 2-year follow-up was target lesion failure, a composite of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization. Among 522 DCB-treated lesions (466 patients), dissections were angiographically evident in 39.1% of cases, with 21.1% which underwent bail-out stenting and 78.9% left untreated. The incidence of bail-out stenting increased from type A to type E dissections (p for trend <0.001). Left anterior descending artery involvement (odds ratio 1.64, 95% confidence interval 1.12 to 2.39) was the strongest risk factors for dissection. Target lesion failure at 2 years occurred in 2.7% of lesions with untreated dissection compared with 4.2% of those with no dissection (log-rank p = 0.324). In conclusion, coronary dissections often complicate PCI with DCB angioplasty but do not correlate with increased risk of adverse events at midterm follow-up.
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Affiliation(s)
- Mauro Gitto
- Department of Biomedical Sciences; Humanitas University; Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy; Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pier Pasquale Leone
- Department of Biomedical Sciences; Humanitas University; Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy; Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Francesco Gioia
- Department of Biomedical Sciences; Humanitas University; Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Mauro Chiarito
- Department of Biomedical Sciences; Humanitas University; Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Alessia Latini
- Department of Biomedical Sciences; Humanitas University; Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Francesco Tartaglia
- Department of Biomedical Sciences; Humanitas University; Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Ismail Dogu Kilic
- Department of Cardiology, Pamukkale University Hospitals, Denizli, Turkey
| | | | | | | | - Ottavia Cozzi
- Department of Biomedical Sciences; Humanitas University; Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Alessandro Sticchi
- Department of Biomedical Sciences; Humanitas University; Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy; University of Pisa, Pisa, Italy
| | - Gianluigi Condorelli
- Department of Biomedical Sciences; Humanitas University; Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Bernhard Reimers
- Department of Biomedical Sciences; Humanitas University; Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences; Humanitas University; Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Antonio Mangieri
- Department of Biomedical Sciences; Humanitas University; Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences; Humanitas University; Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy; EMO-GVM Centro Cuore Columbus, Milan, Italy.
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7
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Lin Q, Zhong K, Pan X, Li C, Lu X, Wang N. Comparison of safety and efficacy of different endovascular treatments for symptomatic intracranial atherosclerotic stenosis: results from a single center. Front Neurol 2025; 16:1539127. [PMID: 40109850 PMCID: PMC11919668 DOI: 10.3389/fneur.2025.1539127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Accepted: 01/24/2025] [Indexed: 03/22/2025] Open
Abstract
Background Symptomatic intracranial atherosclerotic stenosis (sICAS) is one of the common causes of ischemic stroke. However, the treatment of sICAS has remained a challenge in the past with unfavorable findings. This study aimed to evaluate the effectiveness and safety of different endovascular treatment methods for sICAS. Methods The study involved 154 patients with sICAS who received endovascular treatment at Qingdao University Hospital between January 2021 and October 2023. Based on the characteristics of the lesions, three different types of treatments were performed: bare metal stent group (BMS group), drug-coated balloon group (DCB group), and drug-eluting stent group (DES group). The primary endpoints included the incidence of in-stent restenosis (ISR) in the 6-month, periprocedural complications, the rate of stroke recurrence in the area of the stented artery during the follow-up period, and modified Rankin score (mRS) at discharge, at 1-month, at 3-month, at 6-month of patients after stenting. Results The incidence of perioperative complications did not differ significantly between groups (11.3% in the BMS group, 8.0% in the DCB group, and 6.1% in the DES group, p = 0.776). All patients (154/154) had successful reperfusion after endovascular treatment. The incidence of stroke during follow-up was 4.5% (7/154), with 5 (7.0%) patients in the BMS group, 1 (2.0%) patient in the DCB group, and 1 (3.0%) patient in the DES group. The restenosis rate in the BMS group [35.2% (25/71)] tended to be higher than that in the DCB group [6.0% (3/50)] and DES group [9.1% (3/33)]. In multivariate logistic regression analysis, endovascular treatment strategy and vessel distribution were significant independent risk factors for ISR within 6 months (p < 0.05). Conclusion Adverse events and success rates following stent implantation are comparable across therapy groups in individuals with sICAS. When compared to BMS, DES, and DCB reduce the risk of ISR, with the advantages of the DCB appearing to be greater for some high-risk patients with ICAS.
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Affiliation(s)
- Qiao Lin
- Department of General Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Kaiyi Zhong
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xiyue Pan
- Department of General Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Congfang Li
- Department of General Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xiaozhen Lu
- Department of General Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Naidong Wang
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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8
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Gobbi C, Giangiacomi F, Pasero G, Faggiano A, Barbieri L, Tumminello G, Colombo F, Ruscica M, Ardizzone V, Genta E, Mircoli L, Galli S, Carugo S. Efficacy and Safety of Sirolimus-Coated Balloon Angioplasty in De Novo Lesions in Large Coronary Vessels: A Propensity Score-Matched Study. Catheter Cardiovasc Interv 2025; 105:861-869. [PMID: 39778031 DOI: 10.1002/ccd.31402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Revised: 12/18/2024] [Accepted: 12/26/2024] [Indexed: 01/11/2025]
Abstract
BACKGROUND Evidence regarding drug-coated balloon (DCB)-only angioplasty in de novo lesions of large vessels is still limited and mainly focused on paclitaxel-coated balloon. We aimed to analyze the safety and efficacy of sirolimus-coated balloon (SCB)-only angioplasty in de novo lesions in large vessels compared to drug-eluting stent (DES). METHODS In this retrospective, dual-center, case-control study, we enrolled all consecutive patients treated between January 2022 and January 2024 with SCB-only angioplasty in de novo lesion in large vessel (> 2.75 mm) compared to a propensity-score matched contemporary population treated with DES. The primary endpoint was the rate of target lesion revascularization (TLR), while secondary endpoints were cardiac death (CD), target vessel revascularization (TVR), myocardial infarction (MI), and target lesion failure (TLF), defined as a composite of them. RESULTS The mean age was 70.1 ± 9.8 years in the SCB group (n = 92) and 67.9 ± 9.6 years in the DES group (n = 92) (p = 0.76). The median follow-up was 19.5 ± 12 months in the SCB group and 20.1 ± 13.1 months in the DES group (p = 0.47). TLR occurred in 6.7% of patients in the SCB group and 5.6% in the DES group (p = 0.75). The incidence of MI, TVR, and TLF were similar between the two groups (4.3% vs 3.3%, p = 0.7, 2.2% vs 3.4%, p = 0.65% and 9.8% vs 8.7%, p = 0.79). CD occurred in 4.3% in the SCB group, compared to 3.3% in the DES group (p = 0.70). CONCLUSION Our study suggests that SCB angioplasty is both safe and effective in the treatment of de novo lesions of large vessels compared with DES.
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Affiliation(s)
- Cecilia Gobbi
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Giangiacomi
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Guido Pasero
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Andrea Faggiano
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Lucia Barbieri
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gabriele Tumminello
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federico Colombo
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimiliano Ruscica
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valentina Ardizzone
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Interventional Cardiology, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Edoardo Genta
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Interventional Cardiology, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Luca Mircoli
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Galli
- Department of Interventional Cardiology, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Stefano Carugo
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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9
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Gobbi C, Giangiacomi F, Merinopoulos I, Gherbesi E, Faggiano A, Pasero G, Barbieri L, Tumminello G, Colombo F, Mircoli L, Ruscica M, Vassiliou VS, Eccleshall SC, Carugo S. Drug coated balloon angioplasty for de novo coronary lesions in large vessels: a systematic review and meta-analysis. Sci Rep 2025; 15:4921. [PMID: 39929903 PMCID: PMC11811268 DOI: 10.1038/s41598-025-85734-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 01/06/2025] [Indexed: 02/13/2025] Open
Abstract
We aimed to investigate the safety of drug-coated balloon (DCB)-only percutaneous coronary intervention compared to drug-eluting stent (DES) for de novo lesions in large vessels. To pursue this goal, we conducted a systematic review and meta-analysis following the PRISMA guidelines. The analysis included studies that utilized DCB-only or hybrid angioplasty for de novo lesions in large coronary vessel (> 2.75 mm). The primary outcome was to assess the target lesion revascularization (TLR) rate, while secondary outcomes included cardiac death, myocardial infarction (MI), and the composite of these. A total of 15 studies, comprising 3975 patients (of whom 2114 treated with DCB) were included. Median age was 62 ± 1.5 years, with 77.4% being male. Overall, 26.9% had diabetes, and 67.6% were diagnosed with acute coronary syndrome. Over a pooled follow-up of 20.6 ± 1.9 months, the incidence of TLR was 4% in the pooled DBC group. Additionally, over a pooled follow-up of 25.8 ± 2.7 months, no significant differences were observed in incidence of TLR between the DCB group and the DES group (4.3% vs. 6.9%, odds ratio 0.71, 95% confidence interval 0.50-1.01, p = 0.059). Furthermore, there were no differences in incidence of cardiac death and MI. DCB angioplasty treatment of de novo lesions in large coronary vessels could be a safe and effective strategy in both acute and chronic coronary settings. The incidence of target lesion revascularization appears to be similar to that of contemporary DES.
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Affiliation(s)
- Cecilia Gobbi
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy.
| | - Francesco Giangiacomi
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy
| | - Ioannis Merinopoulos
- Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Milan, Italy
| | - Elisa Gherbesi
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Andrea Faggiano
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy
| | - Guido Pasero
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy
| | - Lucia Barbieri
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Gabriele Tumminello
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Federico Colombo
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Luca Mircoli
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Massimiliano Ruscica
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
- Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Milan, Italy
| | - Vassilios S Vassiliou
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich NR4 7UY, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Simon C Eccleshall
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich NR4 7UY, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Stefano Carugo
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122, Milan, Italy
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10
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Fan CH, Chen LF, Cheng J, Wang YQ, Xu LH, Li JM. Predicting plaque regression based on plaque characteristics identified by optical coherence tomography: A retrospective study. Photodiagnosis Photodyn Ther 2025; 51:104473. [PMID: 39761809 DOI: 10.1016/j.pdpdt.2025.104473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Revised: 12/19/2024] [Accepted: 01/03/2025] [Indexed: 01/24/2025]
Abstract
BACKGROUND Atherosclerosis is a lipid-driven, systemic immune-inflammatory disease characterized by the accumulation of plaque within the arterial walls. Plaque regression can occur following appropriate treatment interventions. Optical coherence tomography (OCT), a high-resolution imaging modality, is frequently employed to assess plaque morphology. This study aims to explore the correlation between plaque characteristics identified using OCT, particularly macrophage infiltration, and subsequent plaque regression. METHODS In this retrospective study, data from 112 individuals with coronary artery plaques, who underwent OCT imaging at our hospital, between June 2019 and June 2024, were evaluated. Plaques were classified as lipid-rich, fibrous, or calcified based on the initial OCT findings. Macrophage infiltration levels within each plaque type were quantified. After one year of follow-up, repeat OCT imaging was performed to evaluate plaque regression. Statistical analyses were conducted to assess the relationship between initial plaque characteristics and regression outcomes. RESULTS Plaques that underwent regression were more commonly lipid-rich and exhibited higher levels of macrophage infiltration compared to those without regression. Multivariate analysis identified the histological inflammation score (HIS) as an independent factor influencing plaque regression. CONCLUSION Macrophage-rich plaques, as detected by OCT, are significant predictors of plaque regression. The identification of vulnerable plaque features through OCT can enhance the early diagnosis and treatment strategies for atherosclerotic cardiovascular disease.
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Affiliation(s)
- Cheng-Hui Fan
- Department of Cardiology, Shanghai East Hospital, Nanjing Medical University, Nanjing 211166, China; Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Lyu-Fan Chen
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Jing Cheng
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Yi-Qiong Wang
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Ling-Hao Xu
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200092, China; Department of Endocrinology and Metabolism, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Ji-Ming Li
- Department of Cardiology, Shanghai East Hospital, Nanjing Medical University, Nanjing 211166, China; Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200092, China.
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11
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Camaj A, Leone PP, Colombo A, Vinayak M, Stone GW, Mehran R, Dangas G, Kini A, Sharma SK. Drug-Coated Balloons for the Treatment of Coronary Artery Disease: A Review. JAMA Cardiol 2025; 10:189-198. [PMID: 39714903 DOI: 10.1001/jamacardio.2024.4244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2024]
Abstract
Importance Drug-coated balloon (DCB) angioplasty has emerged as an alternative to drug-eluting stent (DES) implantation for percutaneous coronary intervention (PCI) in patients with coronary in-stent restenosis (ISR) as well as de novo coronary artery disease. Observations DCBs are balloons coated with antiproliferative agents and excipients, whose aim is to foster favorable vessel healing after appropriate lesion preparation. By providing homogeneous antiproliferative drug delivery in the absence of permanent foreign body implantation, DCBs offer multiple advantages over DES, including preservation of vessel anatomy and function and positive vessel remodeling. As such, DCBs have become appealing for treatment of ISR, small-vessel disease, long lesions, simplification of bifurcation procedures, and treatment of diffuse distal disease after recanalization of chronic total occlusions. In addition, patients with high bleeding risk, diabetes, and acute coronary syndrome might also stand to benefit from DCB angioplasty. Conclusions and Relevance Although commercially available in numerous countries now for more than a decade, DCB only recently obtained US Food and Drug Administration approval for the treatment of coronary ISR. Moreover, preliminary results from newer generation devices tested in different clinical scenarios have raised the interest of the international community. Accordingly, an up-to-date review is timely particularly with the anticipated wave of research on the matter. Herein, this review encompasses DCB technologies, their worldwide usage, details on relevant indications, and key procedural aspects of DCB angioplasty.
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Affiliation(s)
- Anton Camaj
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Pier Pasquale Leone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- Cardio Center, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Antonio Colombo
- Cardio Center, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Manish Vinayak
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- Associate Editor, JAMA Cardiology
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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12
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Shin ES, Park Y, Lee JY, Her AY, Chon MK, Kim S, Rha SW, Oh GC, Cho DK, Kim B, Bae JW. A Prospective Randomized Trial Comparing 2 Different Paclitaxel-Coated Balloons in De Novo Coronary Artery Disease. JACC. ASIA 2025; 5:15-24. [PMID: 39886190 PMCID: PMC11775799 DOI: 10.1016/j.jacasi.2024.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 10/28/2024] [Accepted: 10/28/2024] [Indexed: 02/01/2025]
Abstract
Background The Genoss paclitaxel-coated balloon (PCB) is a novel PCB with shellac and vitamin E as excipients, enhancing drug delivery to the target lesion and minimizing restenosis. Objectives This study aimed to compare quantitative coronary angiographic outcomes at 6 months after treatment of de novo coronary artery disease (CAD) with 2 different types of PCBs. Methods This prospective, multicenter, noninferiority trial randomized 204 patients with chronic coronary syndrome or stabilized acute coronary syndrome to treatment with the shellac and vitamin E-based PCB or the reference PCB (SeQuent Please NEO) in a 1:1 ratio. The primary endpoint was noninferiority for the 6-month angiographic in-lesion late lumen loss. Results The 6-month in-lesion late lumen loss was 0.06 ± 0.38 mm with shellac and vitamin E-based PCB vs 0.09 ± 0.36 mm with reference PCB. The 1-sided 97.5% upper confidence limit of the difference was 0.08 mm, which was lower than the noninferiority limit of 0.15 mm, achieving noninferiority (P for noninferiority = 0.001). There was comparable late lumen enlargement (44.7% vs 42.7%; P = 0.903) and binary restenosis rates (3.2% vs 6.7%; P = 0.442) following treatment with shellac and vitamin E-based PCB and reference PCB, respectively. Both PCBs had similar 12-month rates of target vessel failure (3.0% in shellac and vitamin E-based PCB vs 4.3% in reference PCB; P = 0.921). Conclusions The Genoss PCB, formulated with shellac and vitamin E as excipients, demonstrated angiographic outcomes comparable to a clinically proven PCB in the treatment of de novo CAD. (Compare the Safety and Efficacy of Genoss® DCB and SeQuent® Please NEO in Coronary De Novo Lesions; NCT05096442).
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Affiliation(s)
- Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Yongwhi Park
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, South Korea
| | - Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Min-Ku Chon
- Department of Internal Medicine, Pusan National University School of Medicine and Cardiovascular Center and Research institute for Convergence of biomedical science and technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Sunwon Kim
- Department of Cardiology, Korea University Ansan Hospital, Ansan, South Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea
| | - Gyu Chul Oh
- Cardiovascular Center and Cardiology Division, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Deok-Kyu Cho
- Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, South Korea
| | - Bitna Kim
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Jang-Whan Bae
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University, College of Medicine, Cheongju, South Korea
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13
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Verdoia M, Nardin M, Rognoni A, Cortese B. Drug-coated balloons in high-risk patients and diabetes mellitus: A meta-analysis of 10 studies. Catheter Cardiovasc Interv 2024; 104:1423-1433. [PMID: 39465638 DOI: 10.1002/ccd.31257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 08/20/2024] [Accepted: 09/24/2024] [Indexed: 10/29/2024]
Abstract
BACKGROUND Despite the improvements in drug eluting stents (DES) technology, suboptimal results have been observed in certain higher-risk subsets of patients, as in diabetes mellitus (DM). Drug-coated balloons (DCB) could represent an alternative to DES in complex populations and anatomies, as in DM. AIMS The present meta-analysis aimed at assessing the role of DCBs in patients with diabetes mellitus. METHODS Studies comparing DCB versus percutaneous coronary revascularization (PCI) with/without DES for PCI in high-risk populations (>30% DM) were included. The primary efficacy endpoint was overall mortality, secondary endpoints were myocardial infarction, target lesion revascularization (TLR), and major adverse cardiovascular events (MACE). RESULTS We included 10 studies, comprising 2026 patients. Among them, 1002 patients (49.5%) were treated with DCB and 1024 with DES implantation. Among the included studies, 6 only enrolled diabetic patients and 2 had a prevalence of diabetes of 50%. At a mean follow-up of 15.3 months, mortality rate was 3.8% (82 patients), significantly lower with DCB (3.2% vs. 4.9% with DES; odds ratio [OR] [95% confidence interval {CI}] = 0.61 [0.38, 0.97], p = 0.04 phet = 0.34. A similar reduction in favor of DCB was observed for MACE (13.6% vs. 17.6%; OR [95% CI] = 0.79 [0.61, 1.04], p = 0.09, phet = 0.25), while TLR was significantly reduced only in the diabetic-restricted sub-analysis. CONCLUSION In the present meta-analysis, we showed a significant survival benefit and an absolute reduction in MACE and TLR with a DCB-based strategy as compared to DES in high-risk patients, mostly with DM. Future large-scale randomized trials, dedicated to this population, are deserved to confirm our findings. WHAT IS KNOWN Complex coronary anatomies and diabetes mellitus (DM) represent the pitfall of drug eluting stents (DES), mainly due to inflammatory and thrombotic complications, which should be reduced with drug-coated balloons (DCB). WHAT IS NEW We confirmed a significant advantage of DCB versus DES in the treatment of de novo lesions in high-risk patients and mainly in DM, reducing overall mortality, MACE and target lesion revascularization.
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Affiliation(s)
| | - Matteo Nardin
- Department of Internal Medicine, Spedali Civili, Brescia, Italy
| | | | - Bernardo Cortese
- Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy
- DCB Academy, Milano, Italy
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14
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Iwańczyk S, Lazar FL, Onea HL, Pesenti N, Wańha W, Woźniak P, Gościniak W, Prof ML, Cortese B. Sirolimus-coated balloon versus drug-eluting stent for complex coronary lesions. A propensity matched comparison. Int J Cardiol 2024; 415:132436. [PMID: 39153511 DOI: 10.1016/j.ijcard.2024.132436] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Revised: 07/26/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024]
Abstract
INTRODUCTION Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in complex coronary artery disease (CAD) has been established as the standard of care, but stent-related events are not uncommon. Sirolimus-Coated Balloon (SCB)-based angioplasty is an emerging technology, although it needs to be thoroughly evaluated compared with DES in the complex PCI setting. This study aimed to investigate the safety and efficacy of SCB-based angioplasty compared with new-generation DES in complex PCI. METHODS Net adverse cardiovascular events (NACE: all-cause death, target lesion revascularization, non-fatal myocardial infarction, and major bleedings according to BARC classification), as a primary study endpoint was compared between SCB and new-generation DES for complex coronary lesions. RESULTS Among 1782 patients with complex CAD, 1076 were treated with a sirolimus-coated balloon (EASTBOURNE Registry) and 706 with new-generation DES (COMPLEX Registry). After propensity score matching, a total of 512 patients in both groups were analyzed. NACE occurred more significantly in the DES group during the 1-year follow-up (10.5% vs. 3.9%, p = 0.003), mainly due to a higher risk of bleeding (6.6% vs. 0.4%, p = 0.001). The Cox model adjusted for lesion length showed a significantly lower hazard of NACE (HR: 0.23, CI [0.10, 0.52], p < 0.001) and all-cause mortality (HR: 0.07, CI [0.01, 0.66], p = 0.020) in SCB compared to DES group. CONCLUSIONS SCB angioplasty has an advantage over DES for the treatment of complex CAD regarding NACE, significantly reducing the incidence of major bleeding without increasing ischemic endpoints. SCB may be an alternative to DES in selected patients with complex coronary lesions.
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Affiliation(s)
- Sylwia Iwańczyk
- Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland; DCB Academy, Milano, Italy
| | - Florin-Leontin Lazar
- Medical Clinic Number 1, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Horea-Laurentiu Onea
- Medical Clinic Number 1, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Nicola Pesenti
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology, and Public Health, University of Milano-Bicocca, Italy
| | - Wojciech Wańha
- DCB Academy, Milano, Italy; Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Patrycja Woźniak
- Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Weronika Gościniak
- Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Maciej Lesiak Prof
- Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Bernardo Cortese
- DCB Academy, Milano, Italy; Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy; Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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15
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Kang DO, Kim S, Kim B, Her AY, Shin ES. Long-term efficacy of drug-coated balloon-based treatment for de novo left anterior descending artery disease. Sci Rep 2024; 14:24260. [PMID: 39414874 PMCID: PMC11484897 DOI: 10.1038/s41598-024-75201-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Accepted: 10/03/2024] [Indexed: 10/18/2024] Open
Abstract
Drug-coated balloons (DCB) are increasingly utilized in percutaneous coronary intervention (PCI), but their effectiveness in coronary artery disease (CAD) needs further exploration. This study investigates the efficacy and safety of a DCB-based strategy for de novo left anterior descending artery (LAD) disease. Patients with de novo LAD lesions treated with DCB alone or combined with drug-eluting stents (DES) and were retrospectively enrolled from 2010 to 2023 (n = 268). The comparator group consisted of patients treated with second-generation DES from a Korean multicenter registry (n = 4,147). The primary endpoint was three-year major adverse cardiovascular events (MACE), including cardiac death, myocardial infarction, target vessel revascularization, target lesion thrombosis, and major bleeding. In the DCB-based group (n = 268), 218 (81.3%) received DCB-only, while 50 (18.7%) underwent a hybrid approach. After propensity score-matching of 243 paired subjects, baseline characteristics were balanced. The DCB-based PCI reduced overall stent burden by 86.7% and significantly lowered the risk of MACE at three years compared to DES-only PCI (4.5% vs. 7.6%, HR 0.50, 95% CI 0.28-0.90; p = 0.020). The most significant reduction was in major bleeding. The DCB-based approach offers an alternative to DES-only strategy for LAD PCI by reducing three-year MACE risk, supporting its use in treating de novo CAD.
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Affiliation(s)
- Dong Oh Kang
- Cardiovascular Center, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Sunwon Kim
- Cardiovascular Center, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan-si, South Korea
| | - Bitna Kim
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwan-doro, Dong-gu, Dong-gu, Ulsan, 44033, South Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwan-doro, Dong-gu, Dong-gu, Ulsan, 44033, South Korea.
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16
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Cortese B, Malakouti S, Mazhar W, Leontin Lazar F, Munjal A, Ketchanji Mougang Y. Long-term benefits of drug-coated balloons for coronary artery revascularization. Minerva Cardiol Angiol 2024; 72:506-516. [PMID: 38127439 DOI: 10.23736/s2724-5683.23.06425-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) represents the treatment of choice for the majority of patients with coronary artery disease. While currently available DES, in addition to physiological support, has failed to show the non-inferiority to coronary artery bypass grafting (CABG) in terms of cumulative incidence of clinical events over the short-term follow-up. Studies have also shown that DES is associated with an increased risk of target vessel revascularization compared to CABG after long-term follow-up. Drug-coated balloons (DCB) have been shown to provide clinically significant benefits in the management of in-stent restenosis and diffuse coronary artery disease, as well as small coronary artery lesions. The aim of this review was to describe the inherent technical limitations of DES and highlight the potential advantages of PCI with DCB for long-term outcomes and potentially demonstrate its non-inferiority to CABG. Currently, ongoing studies will provide more information and help to understand if a blended therapy of DCB+DES can match the performance of CABG in the need for revascularization in more complex patients.
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Affiliation(s)
- Bernardo Cortese
- Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy -
- DCB Academy, Milan, Italy -
| | | | - Waqas Mazhar
- DCB Academy, Milan, Italy
- Institute of Cardiology of Rawalpindi, Rawalpindi, Pakistan
| | - Florin Leontin Lazar
- Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Clinicilor, Cluj-Napoca, Romania
| | - Amit Munjal
- DCB Academy, Milan, Italy
- Maharaja Agresan Medical College, Agroha, India
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17
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Saito Y, Kobayashi Y. Advances in Technology and Technique in Percutaneous Coronary Intervention: A Clinical Review. Intern Med 2024:4505-24. [PMID: 39343561 DOI: 10.2169/internalmedicine.4505-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2024] Open
Abstract
Percutaneous coronary intervention (PCI) has become the standard procedure for patients with angina and acute coronary syndrome. From the perspective of technology and technique, PCI has advanced over the last four decades, resulting in considerably improved clinical outcomes in patients with coronary artery disease in the current era. In this review article, we summarize recent advances, promising technologies, and areas for research in the field of PCI.
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Affiliation(s)
- Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
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18
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Her AY, Shin ES. Drug-Coated Balloon Treatment for De Novo Coronary Lesions: Current Status and Future Perspectives. Korean Circ J 2024; 54:519-533. [PMID: 38956941 PMCID: PMC11361769 DOI: 10.4070/kcj.2024.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 05/22/2024] [Indexed: 07/04/2024] Open
Abstract
The outstanding development in contemporary medicine, highlighted by percutaneous coronary intervention (PCI), was achieved through the adoption of drug-eluting stents (DESs). Although DES is the established therapy for patients undergoing PCI for de novo coronary artery disease (CAD), their drawbacks include restenosis, stent thrombosis, and the requirement for dual antiplatelet therapy (DAPT) with an uncertain duration regarding its optimality. Drug-coated balloon (DCB) treatment leaves nothing behind on the vessel wall, providing the benefit of avoiding stent thrombosis and not necessitating obligatory extended DAPT. After optimizing coronary blood flow, DCB treatment delivers an anti-proliferative drug directly coated on a balloon. Although more evidence is needed for the application of DCB treatment in de novo coronary lesions, recent studies suggest the safety and effectiveness of DCB treatment for diverse conditions including small and large vessel diseases, complex lesions like bifurcation lesions or diffuse or multivessel diseases, chronic total occlusion lesions, acute myocardial infarctions, patients at high risk of bleeding, and beyond. Consequently, we will review the current therapeutic choices for managing de novo CAD using DCB and assess the evidence supporting their concurrent application. Additionally, it aims to discuss future important perspectives.
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Affiliation(s)
- Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
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19
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Mukheja Y, Sarkar A, Arora R, Pal K, Ahuja A, Vashishth A, Kuhad A, Chopra K, Jain M. Unravelling the progress and potential of drug-eluting stents and drug-coated balloons in cardiological insurgencies. Life Sci 2024; 352:122908. [PMID: 39004270 DOI: 10.1016/j.lfs.2024.122908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 07/01/2024] [Accepted: 07/08/2024] [Indexed: 07/16/2024]
Abstract
AIM Coronary artery disease (CAD) is the leading cause of mortality. Though percutaneous transluminal angioplasty followed by stenting is still the default treatment of choice for revascularization of obstructive CAD, the high rate of restenosis compromises the outcomes of endovascular procedures. To overcome restenosis, drug-eluting stents (DES) and drug-coated balloons (DCB) are designed that release antiproliferative drugs like sirolimus, paclitaxel, everolimus, etc., over time to inhibit cell growth and proliferation. Our review aims to summarize the challenges and progress of DES/DCBs in clinical settings. MATERIAL AND METHODS The comprehensive review, search and selection encompasses in relevant articles through Google Scholar, Springer online, Cochrane library and PubMed that includes research articles, reviews, letters and communications, various viewpoints, meta-analyses, randomized trials and quasi-randomized trials. Several preclinical and clinical data have been included from National Institutes of Health and clinicaltrials.gov websites. KEY FINDINGS Challenges like delayed endothelialization, stent thrombosis (ST), and inflammation was prominent in first-generation DES. Second-generation DES with improved designs and drug coatings enhanced biocompatibility with fewer complications. Gradual absorption of bioresorbable DES over time mitigated long-term issues associated with permanent implants. Polymer-free DES addressed the inflammation concerns but still, they leave behind metallic stents in the vasculature. As an alternative therapeutic strategy, DCB were developed to minimize inflammation in the vessel. Although both DES and DCBs have shown considerable progress, challenges persist. SIGNIFICANCE This review illustrates the advancements in the designs, preparation technologies, biodegradable materials, and drugs used as well as challenges associated with DES and DCBs in clinical settings.
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Affiliation(s)
- Yashdeep Mukheja
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Ankan Sarkar
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Rubal Arora
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Kashish Pal
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Akanksha Ahuja
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Anushka Vashishth
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Anurag Kuhad
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Kanwaljit Chopra
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
| | - Manish Jain
- University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India.
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Eccleshall S, Scheller B. Less metal - the latest evolution in PCI. ASIAINTERVENTION 2024; 10:155-156. [PMID: 39347106 PMCID: PMC11413634 DOI: 10.4244/aij-e-24-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Affiliation(s)
- Simon Eccleshall
- Department of Cardiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom
| | - Bruno Scheller
- Clinical and Experimental Interventional Cardiology, Saarland University, Homburg, Germany
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21
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Kang DO, Kim SW, Jeong YH. Exploring New Avenues for De Novo Coronary Artery Disease: Next Steps Forward With Drug-Coated Balloons. JACC. ASIA 2024; 4:532-535. [PMID: 39101108 PMCID: PMC11291394 DOI: 10.1016/j.jacasi.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Affiliation(s)
- Dong Oh Kang
- Cardiovascular Center, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Sang-Wook Kim
- CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Young-Hoon Jeong
- CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea
- Division of Cardiology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea
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22
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Joh HS, Kwon W, Shin D, Lee SH, Hong YJ, Hong D, Lee SY, Park H, Kim S, Lee SY, Koh JS, Kim H, Kim CJ, Choo EH, Yoon HJ, Park SD, Jeon KH, Bae JW, Ahn SG, Kim SE, Choi KH, Park TK, Yang JH, Song YB, Hahn JY, Choi SH, Gwon HC, Lee JM. Drug-Coated Balloon Angioplasty in Patients Undergoing Complex Percutaneous Coronary Intervention. JACC. ASIA 2024; 4:519-531. [PMID: 39101114 PMCID: PMC11291392 DOI: 10.1016/j.jacasi.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/05/2024] [Accepted: 04/16/2024] [Indexed: 08/06/2024]
Abstract
Background There are limited clinical data on drug-coated balloon (DCB)-based percutaneous coronary intervention (PCI) compared with drug-eluting stent (DES)-only PCI in patients with complex coronary artery lesions. Objectives The goal of the current study was to investigate the efficacy of DCB in patients undergoing PCI for complex coronary artery lesions. Methods From an institutional registry of patients with de novo complex coronary artery lesions, 126 patients treated with DCB-based PCI were compared with 234 propensity score-matched patients treated with DES-only PCI. Complex coronary artery lesions were defined as the presence of at least 1 of the following: bifurcation, chronic total occlusion, unprotected left main disease, long lesion ≥38 mm, multivessel disease, lesion requiring ≥3 devices, or severe calcification. The primary endpoint was target vessel failure (TVF) at 2 years, a composite of cardiac death, target vessel-related myocardial infarction, and target vessel revascularization. Results Baseline characteristics were comparable between the 2 groups. DCB-based PCI showed a comparable risk of TVF vs DES-based PCI (7.6% vs 8.1%; HR: 0.81; 95% CI: 0.33-1.99; P = 0.638). The risks of cardiac death (5.0% vs 5.7%; HR: 0.78; 95% CI: 0.24-2.49), target vessel-related myocardial infarction (0.9% vs 1.3%; HR: 2.65; 95% CI: 0.26-27.06), and target vessel revascularization (3.5% vs 2.0%; HR: 1.30; 95% CI: 0.30-5.67) were also comparable between the 2 groups. Conclusions DCB-based PCI showed comparable risks of TVF vs those of DES-only PCI in patients with complex coronary artery lesions. DCB might be considered as a suitable alternative device to DES in patients undergoing complex PCI. (Long-term Outcomes and Prognostic Factors in Patient Undergoing CABG or PCI; NCT03870815).
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Affiliation(s)
- Hyun Sung Joh
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Woochan Kwon
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Doosup Shin
- Department of Cardiology, St. Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Seung Hun Lee
- Department of Internal Medicine and Cardiovascular Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Young Joon Hong
- Department of Internal Medicine and Cardiovascular Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - David Hong
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Yoon Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hanbit Park
- Department of Cardiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon-do, Republic of Korea
| | - Sunwon Kim
- Department of Cardiology, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Sang Yeub Lee
- Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea
| | - Jin-Sin Koh
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Hangyul Kim
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Chan Joon Kim
- Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Ho Choo
- Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hyuck-Jun Yoon
- Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Sang Don Park
- Inha University Hospital, Incheon, Republic of Korea
| | - Ki-Hyun Jeon
- Division of Cardiovascular Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jang-Whan Bae
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Sung Gyun Ahn
- Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Sung Eun Kim
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Ki Hong Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taek Kyu Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Hoon Yang
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Bin Song
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo-Yong Hahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Hyuk Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyeon-Cheol Gwon
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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23
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Shin ES, Her AY, Jang MH, Kim B, Kim S, Liew HB. Impact of Drug-Coated Balloon-Based Revascularization in Patients with Chronic Total Occlusions. J Clin Med 2024; 13:3381. [PMID: 38929910 PMCID: PMC11204241 DOI: 10.3390/jcm13123381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/03/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Percutaneous coronary intervention (PCI) with a drug-eluting stent (DES) for chronic total coronary occlusions (CTOs) improves clinical symptoms and quality of life. However, data on drug-coated balloon (DCB)-based PCI in CTO lesions are limited. Methods: A total of 200 patients were successfully treated for CTO lesions, either with DCB alone or in combination with DES (DCB-based PCI). They were compared with 661 patients who underwent second-generation DES implantation for CTO from the PTRG-DES registry (DES-only PCI). The endpoint was major adverse cardiovascular events (MACEs), which included a composite of cardiac death, myocardial infarction, stent or target lesion thrombosis, target vessel revascularization, and major bleeding at 2 years. Results: In the DCB-based PCI group, 49.0% of patients were treated with DCB only and 51.0% underwent the hybrid approach combining DCB with DES. Bailout stenting was performed in seven patients (3.5%). The DCB-based PCI group exhibited fewer stents (1.0; IQR: 0.0-1.0 and 2.0; IQR: 1.0-3.0, p < 0.001), shorter stent lengths (6.5 mm; IQR: 0.0-38.0 mm and 42.0 mm; IQR: 28.0-67.0 mm, p < 0.001), and lower usage of small stents with a diameter of 2.5 mm or less (9.8% and 36.5%, p < 0.001). Moreover, the DCB-based PCI group had a lower rate of MACEs than the DES-only PCI group (3.1% and 13.2%, p = 0.001) at 2-year follow-up. Conclusions: The DCB-based PCI approach significantly reduced the stent burden, particularly in the usage of small stent diameters, and resulted in a lower risk of MACEs compared to DES-only PCI in CTO lesions.
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Affiliation(s)
- Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea; (M.H.J.); (B.K.)
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon 24289, Republic of Korea
| | - Mi Hee Jang
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea; (M.H.J.); (B.K.)
| | - Bitna Kim
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea; (M.H.J.); (B.K.)
| | - Sunwon Kim
- Department of Cardiology, Korea University Ansan Hospital, Ansan 15355, Republic of Korea;
| | - Houng Bang Liew
- Cardiology Department and Clinical Research Center, Queen Elizabeth Hospital II, Kota Kinabalu 88300, Malaysia;
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24
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Wang W, Yang X, Hu Y, Leng X, Xiang J, Lin X. Angiography-based Fractional Flow Reserve for the Prediction of Clinical Outcomes After Drug-coated Balloon or Plain Old Balloon Angioplasty. Cardiovasc Drugs Ther 2024:10.1007/s10557-024-07575-z. [PMID: 38805160 DOI: 10.1007/s10557-024-07575-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND AccuFFRangio is a novel method for fast computation of fractional flow reserve (FFR) based on coronary angiography and computational fluid dynamics. The association between the AccuFFRangio and clinical outcomes after drug-coated balloon (DCB) or plain old balloon angioplasty (POBA) remains to be investigated. METHODS This study included consecutive patients who underwent balloon angioplasty from December 2016 to October 2020. AccuFFRangio was calculated retrospectively based on the post-procedural angiography obtained immediately after angioplasty. The primary endpoint was major adverse cardiac events (MACE), defined as a composite of all-cause death, vessel-related myocardial infarction, and repeat target vessel revascularization. RESULTS A total of 169 patients were retrospectively analyzed in this study. Post-procedural AccuFFRangio (hazard ratio [HR] per 0.1 increase 0.33, 95% confidence interval [CI] 0.22-0.48, p < 0.001) was an independent predictor for MACE at 2-year follow-up. Post-procedural AccuFFRangio ≤ 0.87 was determined as the optimal cutoff value to predict MACE with an area under the curve (AUC) of 0.872 (95% CI 0.813-0.919, p < 0.001). CONCLUSIONS AccuFFRangio measured immediately after balloon angioplasty is a promising predictor of unfavorable clinical outcomes.
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Affiliation(s)
- Wei Wang
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022, China
| | - Xinyi Yang
- ArteryFlow Innovation Institute, 459 Qianmo Road, Hangzhou, 310051, China
| | - Yumeng Hu
- ArteryFlow Innovation Institute, 459 Qianmo Road, Hangzhou, 310051, China
| | - Xiaochang Leng
- ArteryFlow Innovation Institute, 459 Qianmo Road, Hangzhou, 310051, China
| | - Jianping Xiang
- ArteryFlow Innovation Institute, 459 Qianmo Road, Hangzhou, 310051, China.
| | - Xianhe Lin
- Department of Cardiology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, 230022, China.
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Her AY, Kim B, Kim S, Kim YH, Scheller B, Shin ES. Comparison of angiographic change in side-branch ostium after drug-coated balloon vs. drug-eluting stent vs. medication for the treatment of de novo coronary bifurcation lesions. Eur J Med Res 2024; 29:280. [PMID: 38735968 PMCID: PMC11089776 DOI: 10.1186/s40001-024-01877-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 05/01/2024] [Indexed: 05/14/2024] Open
Abstract
OBJECTIVES Data on side-branch (SB) ostial effect after drug-coated balloon (DCB) treatment in the context of de novo coronary bifurcation lesions are limited. We aimed to investigate the angiographic outcomes of SB ostium after DCB treatment compared with drug-eluting stents (DESs) implantation in the main vessel (MV) or optimal medical therapy (OMT) for the treatment of de novo coronary bifurcation lesions. METHODS Serial angiographic changes in the SB ostium were compared between DCB, DES, and medication alone for MV treatment. Δ value was calculated by subtracting the follow-up value from the pre-procedure value. RESULTS A total of 132 bifurcation lesions were included for analysis (44 lesions in DCB group; 38 lesions in DES group; 50 lesions in OMT group). The minimal lumen diameter (MLD) of SB ostium showed an increase at follow-up in the DCB group, whereas a decrease was observed in both the DES and OMT groups (ΔMLD: -0.16 ± 0.45 mm for DCB group vs. 0.50 ± 0.52 mm for DES group vs. 0.08 ± 0.38 mm for OMT group, p < 0.001). The diameter stenosis (DS) of SB ostium showed a marked decrease at follow-up in the DCB group, in contrast to an increase observed in both the DES and OMT groups (ΔDS: 8.01 ± 18.96% for DCB group vs. -18.68 ± 18.60% for DES group vs. -2.05 ± 14.58% for OMT group, p < 0.001). CONCLUSIONS In de novo coronary bifurcation lesions, DCB treatment on the MV demonstrated favorable angiographic outcomes in the SB ostium at 6-9 month follow-up compared to DES implantation or OMT.
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Affiliation(s)
- Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Bitna Kim
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwan-doro, Dong-Gu, Ulsan, 44033, South Korea
| | - Sunwon Kim
- Department of Cardiology, Korea University Ansan Hospital, Ansan-Si, South Korea
| | - Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Bruno Scheller
- Universität Des Saarlandes, Campus Homburg, 66421, Homburg, Germany
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwan-doro, Dong-Gu, Ulsan, 44033, South Korea.
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26
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Funatsu A, Sato T, Koike J, Mizobuchi M, Kobayashi T, Nakamura S. Comprehensive clinical outcomes of drug-coated balloon treatment for coronary artery disease. Insights from a single-center experience. Catheter Cardiovasc Interv 2024; 103:404-416. [PMID: 38214114 DOI: 10.1002/ccd.30945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/29/2023] [Accepted: 12/14/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Some clinical trials have verified the efficacy and safety of paclitaxel drug-coated balloon (DCB) for small vessel coronary artery disease. However, nonsmall vessel and calcified lesions received less attention. AIMS This study aimed to investigate the efficacy of DCB treatment for various types of coronary artery lesions, including not only small vessel disease but also nonsmall vessel disease and calcified lesions. In this real-world clinical practice study, in-stent restenosis was excluded. METHODS This study consecutively included 934 patients with 1751 nonstented lesions who received DCB at a cardiovascular center in Kyoto Katsura Hospital in Japan between 2009 and 2012 and 2014 to 2019. This study enrolled and retrospectively analyzed all of the patients. Eligible patients routinely underwent follow-up angiography at 6-8 months after percutaneous coronary intervention. The primary endpoint includes target lesion revascularization (TLR) during follow-up. Further, this study calculated the predictor of TLR using multivariate analysis. RESULTS This study included the lesions involving 46.4% of type B2/C, 26.9% with severe calcification, and 6.0% with DCB restenosis. Mean DCB diameter and length were 2.75 ± 0.51 mm and 24.2 ± 9.6 mm, respectively. The median follow-up duration was 18 months. Follow-up angiography revealed a TLR rate of 9% and a restenosis rate of 9%. This study identified hemodialysis and current smoking as independent TLR predictors. CONCLUSION In routine clinical practice, the effectiveness of DCB was observed consistently across various types of coronary artery disease.
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Affiliation(s)
| | - Tatsushi Sato
- Cardiovascular Center, Kyoto Katsura Hospital, Kyoto, Japan
| | - Jumpei Koike
- Cardiovascular Center, Kyoto Katsura Hospital, Kyoto, Japan
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Lazar FL, Onea HL, Olinic DM, Cortese B. A 2024 scientific update on the clinical performance of drug-coated balloons. ASIAINTERVENTION 2024; 10:15-25. [PMID: 38425817 PMCID: PMC10900242 DOI: 10.4244/aij-d-23-00010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 10/12/2023] [Indexed: 03/02/2024]
Abstract
Continuous advances in the field of interventional cardiology have led to the development of drug-coated balloons (DCB). These represent a promising device for overcoming the well-known limitations of traditional metallic stents, which are associated with a persistent yearly increased risk of adverse events. This technology has the ability to homogeneously transfer the drug into the vessel wall in the absence of a permanent prosthesis implanted in the coronary vessel. Robust data support the use of DCB for the treatment of in-stent restenosis, but there is also currently growing evidence from long-term follow-up of large randomised clinical trials regarding the use of these devices in other scenarios, such as de novo small and large vessel disease, complex bifurcations, and diffuse coronary disease. Other critical clinical settings such as diabetes mellitus, high bleeding risk patients and acute coronary syndromes could be approached in the upcoming future by using DCB, alone or as part of a blended strategy in combination with drug-eluting stents. There have been important scientific and technical advances in the DCB field in recent years. The purpose of this paper is to review the most current data regarding the use of DCB, including the mid- and long-term follow-up reports on the safety and efficacy of this novel strategy in different clinical and angiographic scenarios.
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Affiliation(s)
- Florin-Leontin Lazar
- Iuiliu Hatieganu University of Medicine and Pharmacy, 5th Department, Internal Medicine, Medical Clinic No. 1, Cluj-Napoca, Romania
| | - Horea-Laurentiu Onea
- Iuiliu Hatieganu University of Medicine and Pharmacy, 5th Department, Internal Medicine, Medical Clinic No. 1, Cluj-Napoca, Romania
| | - Dan-Mircea Olinic
- Iuiliu Hatieganu University of Medicine and Pharmacy, 5th Department, Internal Medicine, Medical Clinic No. 1, Cluj-Napoca, Romania
| | - Bernardo Cortese
- Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
- DCB Academy, Milan, Italy
- CardioParc, Lyon, France
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28
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Gitto M, Sticchi A, Chiarito M, Novelli L, Leone PP, Mincione G, Oliva A, Condello F, Rossi ML, Regazzoli D, Gasparini G, Cozzi O, Stefanini GG, Condorelli G, Reimers B, Mangieri A, Colombo A. Drug-Coated Balloon Angioplasty for De Novo Lesions on the Left Anterior Descending Artery. Circ Cardiovasc Interv 2023; 16:e013232. [PMID: 37874646 DOI: 10.1161/circinterventions.123.013232] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Drug-coated balloons (DCB) are an emerging tool for modern percutaneous coronary intervention (PCI), but evidence on their use for de novo lesions on large vessels is limited. METHODS Consecutive patients undergoing DCB-based PCI on the left anterior descending artery in 2 Italian centers from 2018 to 2022 were retrospectively enrolled and compared with patients who received left anterior descending PCI with contemporary drug-eluting stents (DES). In-stent restenosis was excluded. The DCB group included both patients undergoing DCB-only PCI and those receiving hybrid PCI with DCB and DES combined. The primary end point was target lesion failure at 2 years, defined as the composite of target lesion revascularization, cardiac death, and target vessel myocardial infarction. RESULTS We included 147 consecutive patients undergoing DCB-based treatment on the left anterior descending artery and compared them to 701 patients who received conventional PCI with DES. In the DCB group, 43 patients (29.2%) were treated with DCB only and 104 (70.8%) with a hybrid approach; DCB length was greater than stent length in 55.1% of cases. Total treated length was higher in the DCB group (65 [40-82] versus 56 [46-66] mm; P=0.002), while longer DESs were implanted (38 [24-62] versus 56 [46-66] mm; P<0.001) and a higher rate of large vessels were treated (76.2% versus 83.5%; P=0.036) in the DES cohort. The cumulative 2-year target lesion failure incidence was not significantly different between the 2 groups (DCB, 4.1% versus DES, 9.8%; hazard ratio, 0.51 [95% CI, 0.20-1.27]; P=0.15). After a 1:1 propensity score matching resulting in 139 matched pairs, the DCB-based treatment was associated with a lower risk for target lesion failure at 2 years compared with DES-only PCI (hazard ratio, 0.2 [95% CI, 0.07-0.58]; P=0.003), mainly driven by less target lesion revascularization. CONCLUSIONS A DCB-based treatment approach for left anterior descending revascularization allows a significantly reduced stent burden, thereby potentially limiting target lesion failure risk at midterm follow-up.
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Affiliation(s)
- Mauro Gitto
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Alessandro Sticchi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Laura Novelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Gianluca Mincione
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Angelo Oliva
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Francesco Condello
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | | | - Damiano Regazzoli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Gabriele Gasparini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Ottavia Cozzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Gianluigi Condorelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (M.G., A.S., M.C., L.N., P.P.L., G.M., A.O., F.C., D.R., G.G., O.C., G.G.S., G.C., B.R., A.M., A.C.)
- EMO-GVM Centro Cuore Columbus, Milan, Italy (M.L.R., A.C.)
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Colombo A, Leone PP. Redefining the way to perform percutaneous coronary intervention: a view in search of evidence. Eur Heart J 2023; 44:4321-4323. [PMID: 37038750 DOI: 10.1093/eurheartj/ehad215] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Affiliation(s)
- Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20072, Pieve Emanuele, Milan, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy
| | - Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20072, Pieve Emanuele, Milan, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089, Rozzano, Milan, Italy
- Division of Cardiology, Montefiore Medical Center, 111 East 210th Street Bronx, NY 10467, USA
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Her AY, Shin ES, Kim S, Kim B, Kim TH, Sohn CB, Choi BJ, Park Y, Cho JR, Jeong YH. Drug-coated balloon-based versus drug-eluting stent-only revascularization in patients with diabetes and multivessel coronary artery disease. Cardiovasc Diabetol 2023; 22:120. [PMID: 37210516 DOI: 10.1186/s12933-023-01853-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/07/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Data on drug-coated balloon (DCB) treatment in the context of diabetes mellitus (DM) and multivessel coronary artery disease (CAD) are limited. We aimed to investigate the clinical impact of DCB-based revascularization on percutaneous coronary intervention (PCI) in patients with DM and multivessel CAD. METHODS A total of 254 patients with multivessel disease (104 patients with DM) successfully treated with DCB alone or combined with drug-eluting stent (DES) were retrospectively enrolled (DCB-based group) and compared with 254 propensity-matched patients treated with second-generation DES from the PTRG-DES registry (n = 13,160 patients) (DES-only group). Major adverse cardiovascular events (MACE) comprised cardiac death, myocardial infarction, stroke, stent or target lesion thrombosis, target vessel revascularization, and major bleeding at 2 years. RESULTS The DCB-based group was associated with a reduced risk of MACE in patients with DM (hazard ratio [HR] 0.19, 95% confidence interval [CI] 0.05-0.68, p = 0.003], but not in those without DM (HR 0.52, 95% CI 0.20-1.38, p = 0.167) at the 2-year follow-up. In patients with DM, the risk of cardiac death was lower in the DCB-based group than the DES-only group, but not in those without DM. In both patients with or without DM, the burdens of DES and small DES (less than 2.5 mm) used were lower in the DCB-based group than in the DES-only group. CONCLUSIONS In multivessel CAD, the clinical benefit of a DCB-based revascularization strategy appears to be more evident in patients with DM than in those without DM after 2 years of follow-up. (Impact of Drug-Coated Balloon Treatment in De Novo Coronary Lesion; NCT04619277).
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Affiliation(s)
- Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan, 44033, South Korea.
| | - Sunwon Kim
- Department of Cardiology, Korea University Ansan Hospital, Ansan-si, South Korea
| | - Bitna Kim
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwan-doro, Dong-gu, Ulsan, 44033, South Korea
| | - Tae-Hyun Kim
- Department of Cardiology, Ulsan Medical Center, Ulsan, South Korea
| | - Chang-Bae Sohn
- Department of Cardiology, Ulsan Medical Center, Ulsan, South Korea
| | - Byung Joo Choi
- Department of Cardiology, Ulsan Medical Center, Ulsan, South Korea
| | - Yongwhi Park
- Department of Internal Medicine, Cardiovascular Center, Gyeongsang National University School of Medicine, Gyeongsang, South Korea
| | - Jung Rae Cho
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Young-Hoon Jeong
- Division of Cardiology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, South Korea
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