Assessment of Paclitaxel Drug-Coated Balloon Only Angioplasty in STEMI

Merinopoulos, Ioannis; Gunawardena, Tharusha; Corballis, Natasha; Bhalraam, U; Reinhold, Johannes; Wickramarachchi, Upul; Maart, Clint; Gilbert, Tim; Richardson, Paul; Sulfi, Sreekumar; Sarev, Toomas; Sawh, Chris; Wistow, Trevor; Ryding, Alisdair; Mohamed, Mohamed; Perperoglou, Aris; Mamas, Mamas A.; Vassiliou, Vassilios; Eccleshall, Simon

doi:10.1016/j.jcin.2023.01.380

Cited by 27 publications

(12 citation statements)

References 21 publications

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“…Our meta-analysis included 13 studies of 2644 patients comparing DCB with DES [ 10 , 16 , 18 – 28 ]. All included studies assessed our primary outcome, MACE.…”

Section: Resultsmentioning

confidence: 99%

Drug-coated balloons versus drug-eluting stents in patients with acute myocardial infarction undergoing percutaneous coronary intervention: an updated meta-analysis with trial sequential analysis

Abdelaziz,

Hafez,

Atta

et al. 2023

BMC Cardiovasc Disord

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Background Drug-coated balloons (DCBs) are an established strategy for coronary artery disease. However, the new generation drug-eluting stent (DES) is recommended for patients with Acute myocardial infarction (AMI) for coronary artery revascularization. Our aim is to provide a comprehensive appraisal of the efficacy of DCBs in patients with AMI undergoing PCI. Methods We searched the WOS, PubMed, Scopus, and Cochrane CENTRAL till March 2023, for studies that compared DCBs versus DES in patients with AMI undergoing PCI. We used a random-effects model to compare major adverse cardiac events (MACE), cardiac death, all-cause death, myocardial infarction, target lesion revascularization (TLR), stent thrombosis, Late lumen Loss (LLL), and minimum lumen diameter (MLD) between the two groups. Results Thirteen studies comprising 2644 patients were included. The pooled OR showed non-inferiority of DCB over DES in terms of MACE (OR = 0.89, 95% CI [0.57 to 1.40], p = 0.63). When we defined MACE as a composite of cardiac death, MI, and TLR; the pooled OR favored DCB over DES (OR = 0.50, 95% CI [0.28 to 0.9], p = 0.02). Moreover, DCB was not inferior to DES in terms of all-cause mortality (OR = 0.88, 95% CI: 0.43 to 1.8, p = 0.73), cardiac mortality, (OR = 0.59, 95% CI: 0.22 to 1.56, p = 0.29), MI (OR = 0.88, 95% CI: 0.34 to 2.29, p = 0.79), stent thrombosis (OR = 1.21, 95% CI: 0.35 to 4.23, p = 0.76), TLR (OR = 0.9, 95% CI: 0.43 to 1.93, p = 0.8), LLL (MD = -0.6, 95% CI: -0.3 to 0.19, p = 0.64), or MLD (MD = -0.4, 95% CI: -0.33 to 0.25, p = 0.76). Conclusion Our meta-analysis indicated that DCB intervention was not inferior to DES in the PCI setting in patients with AMI, and can be recommended as a feasible strategy in AMI. PROSPERO registration CRD42023412757.

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“…Our meta-analysis included 13 studies of 2644 patients comparing DCB with DES [ 10 , 16 , 18 – 28 ]. All included studies assessed our primary outcome, MACE.…”

Section: Resultsmentioning

confidence: 99%

Drug-coated balloons versus drug-eluting stents in patients with acute myocardial infarction undergoing percutaneous coronary intervention: an updated meta-analysis with trial sequential analysis

Abdelaziz,

Hafez,

Atta

et al. 2023

BMC Cardiovasc Disord

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“…The incidence of late STEMI presenters seeking medical attention more than 12 h after symptom onset ranges between 10 and 20%, according to registries [107,108]. This subgroup of patients is known to have a higher rate of hemodynamic instability, a worse chance of systolic function recovery, and higher rates of acute heart failure [109].…”

Section: Invasive Strategy In Late-presenting St-segment Elevation My...mentioning

confidence: 99%

Treatment and Care of Patients with ST-Segment Elevation Myocardial Infarction—What Challenges Remain after Three Decades of Primary Percutaneous Coronary Intervention?

Zuccarelli,

Andreaggi,

Walsh

et al. 2024

JCM

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Primary percutaneous coronary intervention (pPCI) has revolutionized the prognosis of ST-segment elevation myocardial infarction (STEMI) and is the gold standard treatment. As a result of its success, the number of pPCI centres has expanded worldwide. Despite decades of advancements, clinical outcomes in STEMI patients have plateaued. Out-of-hospital cardiac arrest and cardiogenic shock remain a major cause of high in-hospital mortality, whilst the growing burden of heart failure in long-term STEMI survivors presents a growing problem. Many elements aiming to optimize STEMI treatment are still subject to debate or lack sufficient evidence. This review provides an overview of the most contentious current issues in pPCI in STEMI patients, with an emphasis on unresolved questions and persistent challenges.

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“…7 While DCB are an established treatment option for in-stent restenosis and small vessel disease, 8,9 few data are available regarding usage of DCB in large vessels and in combination with DES. [10][11][12][13] Usage of DCB alone or in combination with DES, as part of a hybrid approach, has been proposed to reduce stent burden and overcome the associated complications even in large vessels 13,14 ; however, clinical data supporting the safety and efficacy of such approach are scarce. The aim of the present study was to compare the clinical outcomes of a DCB-based treatment strategy for LAD revascularization, as compared with conventional DES-only PCI.…”

mentioning

confidence: 99%

Drug-Coated Balloon Angioplasty for De Novo Lesions on the Left Anterior Descending Artery

Gitto,

Sticchi,

Chiarito

et al. 2023

Circ: Cardiovascular Interventions

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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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Assessment of Paclitaxel Drug-Coated Balloon Only Angioplasty in STEMI

Cited by 27 publications

References 21 publications

Drug-coated balloons versus drug-eluting stents in patients with acute myocardial infarction undergoing percutaneous coronary intervention: an updated meta-analysis with trial sequential analysis

Drug-coated balloons versus drug-eluting stents in patients with acute myocardial infarction undergoing percutaneous coronary intervention: an updated meta-analysis with trial sequential analysis

Treatment and Care of Patients with ST-Segment Elevation Myocardial Infarction—What Challenges Remain after Three Decades of Primary Percutaneous Coronary Intervention?

Drug-Coated Balloon Angioplasty for De Novo Lesions on the Left Anterior Descending Artery

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