Drug-Coated Balloon Angioplasty Safe Alternative to Stent for Heart Attack Treatment: JACC

UK: A new study published in the Journals of the American College of Cardiology Intervention has shown that drug-coated balloon (DCB) angioplasty may be a safe and effective alternative to the use of drug-eluting stents (DES) in the treatment of ST-segment elevation myocardial infarction (STEMI).

STEMI is a serious type of heart attack caused by a blockage in the blood vessels that supply the heart. DCBs are a type of balloon catheter that is coated with a drug that is released into the blood vessel during the angioplasty procedure. DESs are stents that are coated with a drug that is slowly released over time to help prevent the formation of scar tissue.

In this study, all-cause mortality and net adverse cardiac events were compared between patients treated with the drug-coated balloon (DCB) only or second-generation drug-eluting stents (DES) only for the first presentation of STEMI due to de novo disease. The study included 1139 patients with STEMI due to de novo disease, out of which 452 patients were treated with DCBs and 687 were treated with DES.

Data were analyzed using Cox regression models, Kaplan-Meier estimator plots, and propensity score matching to adjust for differences in baseline characteristics between the two groups.

The study concluded with the following key findings:

1. 1.After a median follow-up period of more than 3 years, all-cause mortality was 49 of 452 in the DCB group and 62 of 687 in the DES group.
2. 2.On multivariable Cox regression analysis, there was no significant difference in mortality between DCBs and DES in both the full and propensity score-matched cohorts.
3. 3.Age, frailty risk, history of heart failure, and family history of ischemic heart disease were significant independent predictors of mortality.
4. 4.There was no significant difference in any of the secondary endpoints, including unplanned TLR.

The study's lead author, Dr. Ioannis Merinopoulos, stated that "These findings suggest that DCB-only angioplasty may be a safe and effective alternative to DES in selected patient groups." It is also noted that "further research is needed to confirm these findings and to identify the patient populations that may benefit the most from DCB angioplasty."

Reference:

Merinopoulos I., et al.; Assessment of Paclitaxel Drug-Coated Balloon Only Angioplasty in STEMI; J Am Coll Cardiol Intv. 2023 Apr, 16 (7) 771–779; doi: 10.1016/j.jcin.2023.01.380