TCT CONNECT-245 A Meta-Analysis of Drug-Coated Balloon Versus Drug-Eluting Stent in De Novo Small Vessel Coronary Artery Disease

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Conference Proceeding

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Journal of American College of Cardiology


Background: Revascularization of small vessel coronary artery disease (SvCAD) is associated with high rate of adverse clinical outcomes. Drug-coated balloon (DCB) is an emerging alternative to drug-eluting stent (DES) in de novo SvCAD. There is limited data about the safety and outcomes of DCB in de-novo SvCAD.

Methods: A meta-analysis was conducted of all studies that compared DCB and DES in de novo SvCAD. This analysis included studies with at least a 1-year follow-up from inception until April 2020. The primary outcome was all-cause mortality. Secondary outcomes included myocardial infarction, and target lesion revascularization. Following an extensive search, this is the first study to include the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) report.

Results: Six studies with a total of 16,591 patients were included. The median-weighted follow-up period was 2.8 years. Two of the 6 studies (BELLO [Balloon Elution and Late Loss Optimization] and BASKET-SMALL2 [Basel Stent Kosten Effektivitäts Trial Drug Eluting Balloons vs. Drug Eluting Stents in Small Vessel Interventions]) were randomized clinical trials, whereas the rest were observational studies. Heterogeneity was low to moderate across the trials (14% to 54%). In terms of the primary outcome, there was no significant difference in all-cause mortality between DCB and DES (Figure). There was also no significant difference found in the secondary outcomes of myocardial infarction and target lesion revascularization between the 2 groups.

Conclusion: This meta-analysis suggests similar clinical outcomes of DCB-treated versus DES-treated de novo SvCAD. According to these results, DCB can be considered as a reasonable treatment option for SvCAD. However, further data including large randomized clinical trials are needed to confirm these results.





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