Drug-coating Balloon Angioplasties for True Coronary Bifurcation Lesions (DCB-BIF)

Comparison of Noncompliant Balloon With Drug-coating Balloon Angioplasties for Side Branch After Provisional Stenting for Patients With True Coronary Bifurcation Lesions

This study is designed to investigate whether drug-coated balloon (DCB) compared to conventional balloon angioplasty for side branch after provisional stenting will lead to lower rates of the composite endpoint of major adverse cardiac event (MACE) at 12 months. The individual components of MACE include cardiac death, myocardial infarction (MI), or target lesion revascularization (TLR). True bifurcation lesions were defined according to Medina classification.

Study Overview

• Status: Active, not recruiting
• Conditions: Coronary Artery Disease
• Intervention / Treatment: Device: Drug-coating balloon

Detailed Description

This is a prospective, multi-center, randomized-controlled, single blind, superiority trial that will include 25 international sites. The investigators aim to enroll 784 subjects with true coronary bifurcation lesions in native coronary arterial segments.

All patients with true coronary bifurcation lesions suitable for angioplasty will undergo 1:1 randomization either to PS (provisional stenting)-DCB or PS-NCB (noncompliant balloon) group using a randomization schedule blocked by site.

All subjects will be screened according to the predefined inclusion and exclusion criteria per protocol and will further undergo angiography after successful stenting of the main vessel with ostium side branch visually estimated stenosis ≥70%. Data and images will be collected during the index procedure, during re-intervention in the case of clinically driven revascularization, and at the predefined 12-month clinical follow-up visit. All subjects will also undergo angiographic follow-up at 13 months.

• Study Type: Interventional
• Enrollment (Actual): 784
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Jiangsu
    • Nanjing, Jiangsu, China, 210006
      • Nanjing First Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Subject must be age ≥18 years.
2. Subject has silent ischemia, or stable/unstable angina, or acute MI older than 1-week from the onset of chest pain to admission.
3. Subject (or legal guardian) understands the trial design and treatment procedures and provides written informal consent before any trial-specific tests or procedures are performed.
4. Subject is willing to comply with all protocol-required follow-up evaluations.
5. Target lesion must be a true bifurcation lesion on coronary angiography (defined as Medina 0,1,1, Medina 1,0,1, or Medina 1,1,1 coronary bifurcation lesions) and is eligible for percutaneous coronary intervention (PCI).
6. Target lesion reference vessel diameter (both main vessel and side branch) ≥ 2.5 mm by visual estimation.
7. Target lesion must have visually estimated stenosis ≥50%.
8. Target lesion length of side branch must be <10 mm by visual estimation.
9. Ostium side branch must have visually estimated stenosis ≥70% after stenting of the main vessel.

Exclusion Criteria:

1. Patient with STEMI (within 1-week from the onset of chest pain to admission).
2. Patient has known allergy to the study balloon/stent system or protocol-required concomitant medications.
3. Patient is intolerable to dual anti-platelet therapy.
4. Patient has any other serious medical illness that may reduce life expectancy to less than 12 months.
5. Patient is pregnant or nursing.
6. Patient is participating in another clinical trial that has not reached its primary endpoint within 24 months after the index procedure.
7. Patient has a planned procedure that may cause non-compliance with the protocol or confound data interpretation.
8. Restenotic lesion.
9. Chronic total occlusion (CTO) lesion in either main vessel or side branch is not successfully recanalized.
10. Severe calcification needing rotational atherectomy.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: PS-DCB; For PS-DCB group; NC balloon dilating ostial side branch (SB) (1:1 ratio).; DCB dilating SB. Specifically, the DCB, which had to be 2-3 mm longer on each side than the predilatation balloon, was inflated at nominal pressure for 30~ 60 s. The ratio of the DCB diameter to the nominal diameter of the SB was recommended to be between 0.8 and 1.0. DCB should be delivered to the lesion within 2 min after entering human body.; Kissing inflation using 2 noncomplian balloons.; Stenting side branch with T and protrusion (TAP) technique if any of the following issues was observed after kissing balloon inflation: >type C dissection or thrombolysis in myocardial infarction (TIMI) flow <3.; Final kissing inflation and proximal optimal technique (POT).	Device: Drug-coating balloon; Provisional stenting technique with DCB; Other Names: DCB
Active Comparator: PS-NCB; For PS-NCB group; NC balloon dilating ostial SB (1:1 ratio).; Kissing inflation using 2 NC balloons.; Stenting side branch with TAP technique if any of the following issues was observed after kissing balloon inflation: >type C dissection or thrombolysis in myocardial infarction (TIMI) flow <3.; Final kissing inflation and proximal optimal technique (POT).	Device: Drug-coating balloon; Provisional stenting technique with DCB; Other Names: DCB

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Rate of major adverse cardiac event	MACE defined as the composite of cardiac death, myocardial infarction (MI), and clinically driven TLR.	12 months after angioplasty

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Rate of all-cause death or cardiac death	In general, all deaths are considered cardiac unless an alternate cause is unequivocally established, even among subjects with serious noncardiac comorbidities.	12 months after angioplasty
Rate of periprocedural MI, Spontaneous MI, or target vessel MI	According to the DCB-BIF trial definition.	12 months after angioplasty
Rate of clinically-driven TLR or TVR	Clinically driven revascularization includes repeat PCI or coronary artery bypass graft (CABG) for recurrent or persistent symptomatic ischemia and can be defined according to the relationship to the index PCI (target lesion).	12 months after angioplasty
Rate of thrombosis	The safety endpoint was stent thrombosis (ST), according to the definition by Academic Research Consortium.	12 months after angioplasty

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Rate of Angiographic success	PCI is considered successful for lesions treated with stent implantation if the residual diameter stenosis based on visual estimation is less than or equal to 10% and the final TIMI flow grade is 3. PCI is considered successful for lesions treated without stent implantation if the residual diameter stenosis based on visual estimation is less than or equal to 20% and the final TIMI flow grade is 3.	1 day
Rate of clinical procedural success	Successful PCI without MACE during hospital stay.	7 day
Crossover rate	From single stent technique to two-stent technique	1 day

Collaborators and Investigators

• Sponsor: Nanjing First Hospital, Nanjing Medical University
• Investigators: Study Chair: Shao-Liang Chen, MD, PhD, Nanjing First Hospital, Nanjing Medical University

Publications and helpful links

General Publications

• Gao XF, Ge Z, Kan J, Kong XQ, Wang Y, Qiu CG, Tresukosol D, He YQ, Wu Q, Li JF, Yuan HT, Shen C, Chen X, Munawar M, Hanif B, Santoso T, Shin ES, Sheiban I, Ye F, Zhang JJ, Chen SL; DCB-BIF investigators. Rationale and design for comparison of non-compliant balloon with drug-coating balloon angioplasty for side branch after provisional stenting for patients with true coronary bifurcation lesions: a prospective, multicentre and randomised DCB-BIF trial. BMJ Open. 2022 Mar 11;12(3):e052788. doi: 10.1136/bmjopen-2021-052788.

Study record dates

Study Major Dates

• Study Start (Actual): September 8, 2020
• Primary Completion (Actual): June 27, 2024
• Study Completion (Estimated): June 30, 2026

Study Registration Dates

• First Submitted: January 20, 2020
• First Submitted That Met QC Criteria: January 23, 2020
• First Posted (Actual): January 27, 2020

Study Record Updates

• Last Update Posted (Estimated): December 15, 2025
• Last Update Submitted That Met QC Criteria: December 7, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Vascular Diseases; Cardiovascular Diseases; Heart Diseases; Arteriosclerosis; Arterial Occlusive Diseases; Coronary Disease; Myocardial Ischemia; Coronary Artery Disease
• Other Study ID Numbers: NFH20191128

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No