A propensity score matched comparative study between paclitaxel‐coated balloon and everolimus‐eluting stents for the treatment of small coronary vessels

Abstract

The use of paclitaxel-DCB appears to be associated with similar clinical outcomes when compared to second-generation-EES in small coronary artery disease. The findings of this study should be confirmed with larger prospective randomized studies with longer follow-up. © 2017 Wiley Periodicals, Inc.

Drug‐coated balloons: “Do they still have a role in treating coronary artery disease?”

“…In the current study, Giannini et al tried to challenge this notion again. They wanted to show that the benefits of DCB therapy for treating small vessel CAD remain even when this therapy is compared to the newer second‐generation everolimus‐eluting stents (EESs).…”

“…Small vessels with coronary artery disease (CAD) pose a unique problem in the interventional world because of the high incidence of restenosis . Drug‐eluting stents (DESs) have been shown to be superior to bare‐metal stents (BMSs) for the treatment of CAD and are currently the mainstay of therapy.…”

“…However, it was thought to be a viable alternative for treating patients with small vessel CAD because DES therapy has been shown to have a high failure rate in that population. By using DCB therapy, physicians can avoid placing foreign material in small coronary vessels while still delivering anti‐proliferative therapy . The Balloon Elution and Late Loss Optimization (BELLO) trial addressed this topic by comparing DCB therapy using the IN.PACT Falcon DCB and bail‐out BMS to the use of first‐generation paclitaxel DES .…”

Drug-Coated Balloon-Only Percutaneous Coronary Intervention for the Treatment of De Novo Coronary Artery Disease: A Systematic Review

“… TLR: DCB 0% vs. DES/BMS 5%, p N.S. (12 months, 100%) DCB 1.5 months, bailout BMS 6 months, DES 12 months Sinaga et al (2016) [ 25 ] SeQuent Please (2nd/3rd-Gen DES) NR MACE: DCB 11.6% vs. DES 11.7%, p = 1.000 TLR: DCB 5.2% vs. DES 3.7%, p = 0.601 (12 months, 100%) DCB 6 months, DES 12 months Giannini et al (2017) [ 22 ] IN.PACT Falcon (2nd-Gen DES) NR MACE*: DCB 12.2% vs. DES 15.4%, p = 0.538 TLR: DCB 5.6% vs. DES 4.4%, p = 0.720 (12 months, 100%) DCB 1 month, Bailout BMS 3 months, DES 12 months Her et al (2017) [ 27 ] SeQuent Please (1st/2nd Gen DES) NR Pericprocedural MI: DCB 1.9% vs. DES 23.1% p = 0.002 TLR: DCB 1% vs. DES 0%, p = 1.00 (12 months, 100%) DCB 1.5 months, DES 12 months Venetsanos et al (2018) [ 26 ] SeQuent Please, Pantera Lux, IN.PACT Falcon (2nd/3rd-Gen DES) NR TLR: DCB 0.2% vs. DES 1.1%, HR: 1.05; (95% CI 0.72–1.53) TLT: DCB 7.0% vs. DES 6.2%, HR: 0.18 (95% CI 0.04–0.82) (30 months, 100%) DCB 1 month, DES 6 months Single-armed observational studies Unverdorben et al PEPCAD I (2010, 2013) [ 17 , 18 ] SeQuent Please In-Segment LLL: 0.28 ± 0.53 (6 months, 89%) MACE: 15.3% TLR: 11.9% (36 months, 100%) DCB 1 month, bailout BMS 3 months Cuculi et al (2012) [ 44 ] IN.PACT Falcon NR TLR: 4.8% (12 months, 95%) 1.5 months Woehrle et al SeQuent Please World Wide Registry (2012) [ 35 ] SeQuent Please NR …”

“…Moreover, only a 1st-generation DES was the comparator. Giannini et al showed comparable clinical outcomes in the BELLO DCB group when propensity score matched against patients treated with a 2nd-generation DES (Xience V or Promus) [ 22 ].…”