Drug-coated Balloons or Drug-eluting Stents – Determining an Optimum Strategy for Patients with High Bleeding Risk

Corballis, Natasha; Nyi, Tha H; Vassiliou, Vassilios; Eccleshall, Simon

doi:10.17925/hi.2020.14.2.100

Heart International

2020

DOI: 10.17925/hi.2020.14.2.100

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Drug-coated Balloons or Drug-eluting Stents – Determining an Optimum Strategy for Patients with High Bleeding Risk

Natasha Corballis¹,

Tha H Nyi²,

Vassilios Vassiliou³

et al.

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2024

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Cited by 2 publications

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Application of Drug‐Coated Balloons in Complex High Risk and Indicated Percutaneous Coronary Interventions

Somsen,

Rissanen,

Hoek

et al. 2024

Cathet Cardio Intervent

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There is a growing trend of patients with significant comorbidities among those referred for percutaneous coronary intervention (PCI). Consequently, the number of patients undergoing complex high risk indicated PCI (CHIP) is rising. CHIP patients frequently present with factors predisposing to extensive drug‐eluting stent (DES) implantation, such as bifurcation and/or heavily calcified coronary lesions, which exposes them to the risks associated with an increased stent burden. The drug‐coated balloon (DCB) may overcome some of the limitations of DES, either through a hybrid strategy (DCB and DES combined) or as a leave‐nothing‐behind strategy (DCB‐only). As such, there is a growing interest in extending the application of DCB to the CHIP population. The present review provides an outline of the available evidence on DCB use in CHIP patients, which comprise the elderly, comorbid, and patients with complex coronary anatomy. Although the majority of available data are observational, most studies support a lower threshold for the use of DCBs, particularly when multiple CHIP factors coexist within a single patient. In patients with comorbidities which predispose to bleeding events (such as increasing age, diabetes mellitus, and hemodialysis) DCBs may encourage shorter dual antiplatelet therapy duration—although randomized trials are currently lacking. Further, DCBs may simplify PCI in bifurcation lesions and chronic total coronary occlusions by reducing total stent length, and allow for late lumen enlargement when used in a hybrid fashion. In conclusion, DCBs pose a viable therapeutic option in CHIP patients, either as a complement to DES or as stand‐alone therapy in selected cases.

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Application of Drug‐Coated Balloons in Complex High Risk and Indicated Percutaneous Coronary Interventions

Somsen,

Rissanen,

Hoek

et al. 2024

Cathet Cardio Intervent

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One-Month Duration Compared with Twelve-Month Duration of Dual Antiplatelet Therapy in Elective Angioplasty for Coronary Artery Disease: Bleeding and Ischaemic Outcomes

Corballis,

Bhalraam,

Merinopoulos

et al. 2024

JCM

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Background/Objectives: The need to determine the safest duration of dual antiplatelet therapy duration after elective angioplasty to reduce bleeding events without an adverse effect on major adverse cardiovascular events (MACE) remains a challenge. Methods: In this investigator-initiated, single-centre cohort study, we identified all patients who underwent PCI for de novo coronary disease for stable angina between January 2015 and November 2019. We compared 1-month and 12-month durations of dual antiplatelet therapy (DAPT) to determine if there was any difference in the primary outcome of major bleeding. The secondary outcome was a patient-oriented composite endpoint of all-cause mortality; any myocardial infarction, stroke, or revascularisation; and the individual components of this composite endpoint. Data were analysed using Cox regression models and cumulative hazard plots. Results: A total of 1025 patients were analysed, of which 340 received 1 month of DAPT and 685 received 12 months of DAPT. There was no difference in major bleeding between the two groups (2.6% vs. 2.5% respectively). On univariable cox regression analysis, no characteristics were predictors of major bleeding. A proportion of 99.7% of patients in the 1-month DAPT arm were treated with a DCB strategy, whilst 93% in the 12-month DAPT group were treated with a DES. There was no difference between the two groups with regards to the composite patient-oriented MACE (11% vs. 12%, respectively) or any individual component of this. These results were unchanged after propensity score matched analysis. Conclusions: A 1-month duration of DAPT, for which 99.7% of patients were treated with a DCB strategy, appears safe and effective when compared with a 12-month duration of DAPT with no difference in major bleeding or MACE.

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Drug-coated Balloons or Drug-eluting Stents – Determining an Optimum Strategy for Patients with High Bleeding Risk

Cited by 2 publications

References 40 publications

Application of Drug‐Coated Balloons in Complex High Risk and Indicated Percutaneous Coronary Interventions

Application of Drug‐Coated Balloons in Complex High Risk and Indicated Percutaneous Coronary Interventions

One-Month Duration Compared with Twelve-Month Duration of Dual Antiplatelet Therapy in Elective Angioplasty for Coronary Artery Disease: Bleeding and Ischaemic Outcomes

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