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Drug-coated balloon: an effective alternative to stent strategy in small-vessel coronary artery disease—a meta-analysis

BACKGROUND: Small-vessel coronary artery disease (CAD) is frequently observed in coronary angiography and linked to a higher risk of lesion failure and restenosis. Currently, treatment of small vessels is not standardized while having drug-eluting stents (DES) or drug-coated balloons (DCBs) as possi...

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Autores principales: Felbel, Dominik, Bozic, Filip, Mayer, Benjamin, Krohn-Grimberghe, Marvin, Paukovitsch, Michael, d’Almeida, Sascha, Mörike, Johannes, Gonska, Birgid, Imhof, Armin, Buckert, Dominik, Rottbauer, Wolfgang, Markovic, Sinisa, Stephan, Tilman
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10475729/
https://www.ncbi.nlm.nih.gov/pubmed/37671137
http://dx.doi.org/10.3389/fcvm.2023.1213992
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author Felbel, Dominik
Bozic, Filip
Mayer, Benjamin
Krohn-Grimberghe, Marvin
Paukovitsch, Michael
d’Almeida, Sascha
Mörike, Johannes
Gonska, Birgid
Imhof, Armin
Buckert, Dominik
Rottbauer, Wolfgang
Markovic, Sinisa
Stephan, Tilman
author_facet Felbel, Dominik
Bozic, Filip
Mayer, Benjamin
Krohn-Grimberghe, Marvin
Paukovitsch, Michael
d’Almeida, Sascha
Mörike, Johannes
Gonska, Birgid
Imhof, Armin
Buckert, Dominik
Rottbauer, Wolfgang
Markovic, Sinisa
Stephan, Tilman
author_sort Felbel, Dominik
collection PubMed
description BACKGROUND: Small-vessel coronary artery disease (CAD) is frequently observed in coronary angiography and linked to a higher risk of lesion failure and restenosis. Currently, treatment of small vessels is not standardized while having drug-eluting stents (DES) or drug-coated balloons (DCBs) as possible strategies. We aimed to conduct a meta-analytic approach to assess the effectiveness of treatment strategies and outcomes for small-vessel CAD. METHODS: Comprehensive literature search was conducted using PubMed, Embase, MEDLINE, and Cochrane Library databases to identify studies reporting treatment strategies of small-vessel CAD with a reference diameter of ≤3.0 mm. Target lesion revascularization (TLR), target lesion thrombosis, all-cause death, myocardial infarction (MI), and major adverse cardiac events (MACE) were defined as clinical outcomes. Outcomes from single-arm and randomized studies based on measures by means of their corresponding 95% confidence intervals (CI) were compared using a meta-analytic approach. Statistical significance was assumed if CIs did not overlap. RESULTS: Thirty-seven eligible studies with a total of 31,835 patients with small-vessel CAD were included in the present analysis. Among those, 28,147 patients were treated with DES (24 studies) and 3,299 patients with DCB (18 studies). Common baseline characteristics were equally distributed in the different studies. TLR rate was 4% in both treatment strategies [0.04; 95% CI 0.03–0.05 (DES) vs. 0.03–0.07 (DCB)]. MI occurred in 3% of patients receiving DES and in 2% treated with DCB [0.03 (0.02–0.04) vs. 0.02 (0.01–0.03)]. All-cause mortality was 3% in the DES group [0.03 (0.02–0.05)] compared with 1% in the DCB group [0.01 (0.00–0.03)]. Approximately 9% of patients with DES developed MACE vs. 4% of patients with DCB [0.09 (0.07–0.10) vs. 0.04 (0.02–0.08)]. Meta-regression analysis did not show a significant impact of reference vessel diameter on outcomes. CONCLUSION: This large meta-analytic approach demonstrates similar clinical and angiographic results between treatment strategies with DES and DCB in small-vessel CAD. Therefore, DES may be waived in small coronary arteries when PCI is performed with DCB.
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spelling pubmed-104757292023-09-05 Drug-coated balloon: an effective alternative to stent strategy in small-vessel coronary artery disease—a meta-analysis Felbel, Dominik Bozic, Filip Mayer, Benjamin Krohn-Grimberghe, Marvin Paukovitsch, Michael d’Almeida, Sascha Mörike, Johannes Gonska, Birgid Imhof, Armin Buckert, Dominik Rottbauer, Wolfgang Markovic, Sinisa Stephan, Tilman Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: Small-vessel coronary artery disease (CAD) is frequently observed in coronary angiography and linked to a higher risk of lesion failure and restenosis. Currently, treatment of small vessels is not standardized while having drug-eluting stents (DES) or drug-coated balloons (DCBs) as possible strategies. We aimed to conduct a meta-analytic approach to assess the effectiveness of treatment strategies and outcomes for small-vessel CAD. METHODS: Comprehensive literature search was conducted using PubMed, Embase, MEDLINE, and Cochrane Library databases to identify studies reporting treatment strategies of small-vessel CAD with a reference diameter of ≤3.0 mm. Target lesion revascularization (TLR), target lesion thrombosis, all-cause death, myocardial infarction (MI), and major adverse cardiac events (MACE) were defined as clinical outcomes. Outcomes from single-arm and randomized studies based on measures by means of their corresponding 95% confidence intervals (CI) were compared using a meta-analytic approach. Statistical significance was assumed if CIs did not overlap. RESULTS: Thirty-seven eligible studies with a total of 31,835 patients with small-vessel CAD were included in the present analysis. Among those, 28,147 patients were treated with DES (24 studies) and 3,299 patients with DCB (18 studies). Common baseline characteristics were equally distributed in the different studies. TLR rate was 4% in both treatment strategies [0.04; 95% CI 0.03–0.05 (DES) vs. 0.03–0.07 (DCB)]. MI occurred in 3% of patients receiving DES and in 2% treated with DCB [0.03 (0.02–0.04) vs. 0.02 (0.01–0.03)]. All-cause mortality was 3% in the DES group [0.03 (0.02–0.05)] compared with 1% in the DCB group [0.01 (0.00–0.03)]. Approximately 9% of patients with DES developed MACE vs. 4% of patients with DCB [0.09 (0.07–0.10) vs. 0.04 (0.02–0.08)]. Meta-regression analysis did not show a significant impact of reference vessel diameter on outcomes. CONCLUSION: This large meta-analytic approach demonstrates similar clinical and angiographic results between treatment strategies with DES and DCB in small-vessel CAD. Therefore, DES may be waived in small coronary arteries when PCI is performed with DCB. Frontiers Media S.A. 2023-08-21 /pmc/articles/PMC10475729/ /pubmed/37671137 http://dx.doi.org/10.3389/fcvm.2023.1213992 Text en © 2023 Felbel, Bozic, Mayer, Krohn-Grimberghe, Paukovitsch, d’Almeida, Mörike, Gonska, Imhof, Buckert, Rottbauer, Markovic and Stephan. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Felbel, Dominik
Bozic, Filip
Mayer, Benjamin
Krohn-Grimberghe, Marvin
Paukovitsch, Michael
d’Almeida, Sascha
Mörike, Johannes
Gonska, Birgid
Imhof, Armin
Buckert, Dominik
Rottbauer, Wolfgang
Markovic, Sinisa
Stephan, Tilman
Drug-coated balloon: an effective alternative to stent strategy in small-vessel coronary artery disease—a meta-analysis
title Drug-coated balloon: an effective alternative to stent strategy in small-vessel coronary artery disease—a meta-analysis
title_full Drug-coated balloon: an effective alternative to stent strategy in small-vessel coronary artery disease—a meta-analysis
title_fullStr Drug-coated balloon: an effective alternative to stent strategy in small-vessel coronary artery disease—a meta-analysis
title_full_unstemmed Drug-coated balloon: an effective alternative to stent strategy in small-vessel coronary artery disease—a meta-analysis
title_short Drug-coated balloon: an effective alternative to stent strategy in small-vessel coronary artery disease—a meta-analysis
title_sort drug-coated balloon: an effective alternative to stent strategy in small-vessel coronary artery disease—a meta-analysis
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10475729/
https://www.ncbi.nlm.nih.gov/pubmed/37671137
http://dx.doi.org/10.3389/fcvm.2023.1213992
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