Drug-Coated Balloon versus Drug-Eluting Stent in Patients with Small-Vessel Coronary Artery Disease: A Meta-Analysis of Randomized Controlled Trials

Xinying Wu, Lun Li, Li He, Xinying Wu, Lun Li, Li He

Abstract

Background: Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) of small-vessel coronary artery disease (SVD) is related to an increased risk of in-stent restenosis (ISR) and stent thrombosis (ST). The application of the drug-coated balloon (DCB) for patients with SVD remains controversial.

Objectives: Assess the outcomes of DCB in the treatment of SVD compared with DES in patients with SVD.

Methods: A meta-analysis of randomized controlled trials (RCTs) published up to June 2020, reporting the outcomes of DCB versus DES in the treatment of SVD, was performed.

Results: Four RCTs with 1227 patients were included. The results indicated that DCB was associated with the decreased risk for myocardial infarction (MI) compared with the DES, but the difference showed no significance (OR 0.50, 95% CI 0.24-1.03, P=0.06). And, there was no significant difference in death (OR 0.76, 95% CI 0.17-3.43, P=0.72), cardiac death (OR 1.92, 95% CI 0.74-4.98, P=0.18), target vessel revascularization (TVR) (OR 0.81, 95% CI 0.51-1.28, P=0.36), target lesion revascularization (TLR) (OR 1.29, 95% CI 0.66-2.52, P=0.46), and major adverse cardiac events (MACE) (OR 0.92, 95% CI 0.61-1.38, P=0.69) between the DCB group and DES group.

Conclusion: Compared with DES, DCB was associated with a decreased risk of MI among patients with SVD, but the difference showed no significance. The application of DCB in SVD is associated with comparable outcomes of death, TVR, and MACE when compared with DES.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Copyright © 2021 Xinying Wu et al.

Figures

Figure 1
Figure 1
Flow diagram of the study selection process.
Figure 2
Figure 2
Risk of bias graph.
Figure 3
Figure 3
Risk of bias summary.
Figure 4
Figure 4
Forest plots comparing DCB with DES in MI, death, cardiac death, TVR, TLR, and MACE. DCB, drug-coated balloon; DES, drug-eluting stent; MACE, major adverse cardiac events; MI, myocardial infarction; TLR, target lesion revascularization; TVR, target vessel revascularization.
Figure 5
Figure 5
Forest plots comparing DCB with DES in MI, TLR, and MACE (excluded PICCOLETO trial). MACE, major adverse cardiac events; MI, myocardial infarction; TLR, target lesion revascularization.

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