Paclitaxel-Coated Balloon Angioplasty Versus Drug-Eluting Stent in Acute Myocardial Infarction

Vos, Nicola S.; Fagel, Nick D.; Amoroso, Giovanni; Herrman, Jean‐Paul R.; Patterson, Mark S.; Piers, Lieuwe H.; Schaaf, René J. van der; Slagboom, Ton; Vink, M

doi:10.1016/j.jcin.2019.04.016

Cited by 149 publications

(130 citation statements)

References 47 publications

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“…Drug-coated balloons (DCB) are an emerging PCI technology negating the need for stent implantation [1][2][3]. Thus far, it has an established role in the treatment of in-stent restenosis [4] with a growing number of studies showing excellent results in de novo coronary artery disease [5][6][7][8][9]. The great majority of DCB used are coated with paclitaxel, but encouraging results have emerged over the last year for the use of sirolimus-coated balloons in coronary artery disease [10,11].…”

Section: Introductionmentioning

confidence: 99%

Long-term safety of paclitaxel drug-coated balloon-only angioplasty for de novo coronary artery disease: the SPARTAN DCB study

et al. 2020

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Objectives We aimed to investigate long-term survival of paclitaxel DCB for percutaneous coronary intervention (PCI). Background Safety concerns have been raised over the use of paclitaxel devices for peripheral artery disease recently, following a meta-analysis suggesting increased late mortality. With regard to drug-coated balloon (DCB) angioplasty for coronary artery intervention however, there is limited data to date regarding possible late mortality relating to paclitaxel. Methods We compared all-cause mortality of patients treated with paclitaxel DCB to those with non-paclitaxel secondgeneration drug-eluting stents (DES) for stable, de novo coronary artery disease from 1st January 2011 till 31st December 2018. To have homogenous groups allowing data on safety to be interpreted accurately, we excluded patients with previous PCI and patients treated with a combination of both DCB and DES in subsequent PCIs. Data were analysed with Kaplan-Meier curves and Cox regression statistical models. Results We present 1517 patients; 429 treated with paclitaxel DCB and 1088 treated with DES. On univariate analysis, age, hypercholesterolaemia, hypertension, peripheral vascular disease, prior myocardial infarction, heart failure, smoking, atrial fibrillation, decreasing estimated glomerular filtration rate (eGFR) [and renal failure (eGFR < 45)] were associated with worse survival. DCB intervention showed a non-significant trend towards better prognosis compared to DES (p = 0.08). On multivariable analysis age, decreasing eGFR and smoking associated with worse prognosis. Conclusion We found no evidence of late mortality associated with DCB angioplasty compared with non-paclitaxel secondgeneration DES in up to 5 years follow-up. DCB is a safe option for the treatment of de novo coronary artery disease.

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Section: Introductionmentioning

confidence: 99%

Long-term safety of paclitaxel drug-coated balloon-only angioplasty for de novo coronary artery disease: the SPARTAN DCB study

et al. 2020

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“…In our case, we decided to proceed with primary PCI using a drug-eluting balloon, as we could not predict the patient's tolerance and response to prolonged DAPT required following stent implantation, given that the patient was recently diagnosed with thrombocytopenia. The stentless approach is also supported by the recent REVascularization with paclitaxELcoated balloon Angioplasty versus drug-eluting stenting in acute myocardial infarcTION (REVELATION) trial which demonstrated that in the setting of STEMI, the drugcoated balloon strategy was noninferior to drug-eluting stent in terms of fractional flow reserve assessed at 9 months and seemed to be safe and feasible [11]. Regarding the access site of the procedure, despite the theoretical advantages of the radial, excellent results have also been reported with the transfemoral approach [3].…”

Section: Discussionmentioning

confidence: 98%

Recurrent Acute Coronary Syndromes in a Patient with Idiopathic Thrombocytopenic Purpura

Iakovis

Xanthopoulos

Chamaidi

et al. 2020

Case Reports in Cardiology

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A 53-year-old man was admitted to a peripheral hospital with the diagnosis of acute myocardial infarction without ST elevation. Due to the concomitant presence of first-diagnosed thrombocytopenia (platelet count 50.000/μL), it was decided to be treated conservatively with clopidogrel. Five days later, he developed an acute myocardial infarction with ST elevation (STEMI) and was transferred to our department for primary percutaneous coronary intervention (PCI). Coronary angiography revealed threevessel disease. The left anterior descending lesion was considered culprit, and PCI was successfully performed using a drugeluting balloon. This approach was considered safer due to the risk of intolerance of prolonged dual antiplatelet therapy in case of stent implantation. Indeed, four days later, aspirin was discontinued, and the patient remained only on clopidogrel due to a platelet fall. Meanwhile, idiopathic thrombocytopenic purpura (ITP) was diagnosed by hematology consultation, and specific ITP treatment was initiated. Seven days following the procedure, the patient was transferred to the Hematology clinic, where a continuous rise of platelet count up to 115.000/μL while on clopidogrel was observed, and he was discharged from the hospital asymptomatic. Unfortunately, twenty days later, the patient died of a lung infection. In ITP patients with STEMI, primary PCI with drug-eluting balloon angioplasty may be a reasonable approach.

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“…Drug-coated balloons represent an established tool in the panorama of vascular interventions, and the “leave nothing behind strategy” (DCB angioplasty with stent implantation only as a bailout for suboptimal results) represents the most appealing and reliable technique in this setting [ 5 ]. Paclitaxel-coated balloons have widely demonstrated their safety and efficacy profiles in terms of both procedural and clinical outcomes in different clinical settings [ 9 , 14 ]. Among lesion settings, ISR and small vessels represent the most interesting fields of application for DCBs because of the attractive possibility of sparing adjunctive metal, respecting vessel anatomy, and reducing the intraluminal bulk.…”

Section: Discussionmentioning

confidence: 99%

“…Of note, our registry confirms such positive findings in an even more complex clinical scenario of ACS patients where STEMI and NSTEMI together represent 84% of the entire population of patients. To date, two studies have reported DCB to be noninferior to DES in the STEMI setting [ 14 , 17 ]. Although there is still a lack of compelling evidence, young STEMI patients (23% in our study) represent an interesting setting for DCB use.…”

Section: Discussionmentioning

confidence: 99%

Sirolimus-Eluting Balloon for the Treatment of Coronary Lesions in Complex ACS Patients: The SELFIE Registry

Caiazzo

Michele

Galluzzi

et al. 2020

Journal of Interventional Cardiology

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Background. Sirolimus-coated balloons (SCBs) represent a novel therapeutic option for both in-stent restenosis (ISR) and de novo coronary lesions treatment, especially in small vessels. Our registry sought to evaluate the procedural and clinical outcomes of such devices in a complex acute coronary syndrome (ACS) clinical setting. Methods and Results. We treated 74 consecutive patients with percutaneous coronary intervention (PCI) with at least 1 SCB used for ISR and/or de novo coronary lesion in small vessels at our institution. Sixty-two patients presented with ACS, and their data were included in our analysis. The mean age was 67 ± 10 years, and patients presenting with ST-elevated myocardial infarction (STEMI) were 14 (23%). De novo lesions were 52%, whereas ISR was 48%. Procedural success occurred in 100% of the cases. At the 11 ± 7 months follow-up, major adverse cardiovascular events (MACEs) were 3 (4.8%). Cardiovascular death (CD) occurred in 1 (1.6%) patient and myocardial infarction (MI) in 2 patients (3.2%) as well as ischemia-driven target lesion revascularization (TLR). One probable subacute thrombosis occurred (1.6%) with no major bleedings. In a subgroup analysis, the incidence of MACE did not show significant differences between patients treated for de novo lesions and ISR (HR: 0.239; CI 95%: 0.003–16.761, p = 0.509 ). Conclusions. In the SELFIE prospective registry, SCB showed a good safety and efficacy profile for the treatment of coronary lesions, both ISR and/or de novo in small vessels, in a complex ACS population of patients at the 11 ± 7 months follow-up.

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Paclitaxel-Coated Balloon Angioplasty Versus Drug-Eluting Stent in Acute Myocardial Infarction

Cited by 149 publications

References 47 publications

Long-term safety of paclitaxel drug-coated balloon-only angioplasty for de novo coronary artery disease: the SPARTAN DCB study

Long-term safety of paclitaxel drug-coated balloon-only angioplasty for de novo coronary artery disease: the SPARTAN DCB study

Recurrent Acute Coronary Syndromes in a Patient with Idiopathic Thrombocytopenic Purpura

Sirolimus-Eluting Balloon for the Treatment of Coronary Lesions in Complex ACS Patients: The SELFIE Registry

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