Comparison Of Drug-Coated Balloon And Drug-Eluting Stent For De Novo Lesions In Coronary Artery Disease

BackgroundAt present,percutaneous coronary intervention with drug-eluting stent(DES)implantation is still the mainstay of non-pharmacological therapy for coronary heart disease,greatly improve the patient's quality of life and clinical prognosis.However,complications following DES angioplasty is inevitable,such as restenosis,late in-stent thrombosis,bleeding risk associated with long-term double anti-platelet therapy(DAPT),stent fracture or allergic to polymer.Drug-coated balloon(DCB)angioplasty is a new kind of therapy for coronary heart disease.It is relatively simple procedure,shorter duration of post-operation DAPT and absence of metal and polymer residue.In recent years,numerous trials regarding the use of DCB to treat in-stent restenosis have concluded that the immediate and long-term outcomes post DCB intervention are non-inferior to those post DES.However,the report regarding a DCB only strategy for de novo coronary lesions is limited.Research objectivesTo compare drug-coated balloon and drug-eluting stent for de novo lesions in coronary artery disease.Research methodThis study enrolled patients with de novo coronary lesions in the Fifth Clinical College of Zhengzhou University from July 2017 to January 2019.According to different intervention strategies,patients were included in the DCB group and the DES group.The target lesion revascularization(TLR)and major adverse cardiovascular events(MACE)were compared between the two groups at 12 months follow-up.Incidence of follow-up related adverse events were compared between the two groups.Angiographic measurements and quantitative coronary analysis were performed before and after the procedure,and at 12 months follow-up.Research results1.A total of 199 patients were included.There were 88 patients with 89 lesions in DCB group and 111 patients with 113 lesions in DES group.The patients in the DCB group were much younger than those in the DES group(58.42±9.17 vs.61.56±8.80,P<0.05)and fewer DCB group patients had diabetes(32.9%vs.46.8%,P<0.05).There were no significant differences in other risk factors and clinical basic information between the two groups(P>0.05).2.The ratio of right coronary artery or its branch lesions in DCB group was higher than that in DES group(30.3%vs.23.3%,P<0.05).Lesion preparations for DCB were more complicated than for DES,such as 76.4%of lesions required the additional use of a cutting balloon(P<0.001),and 18.0%lesions required scoring balloon(P<0.001).3.During the follow-up,the target lesion revascularization(TLR)rates of 3.4%in the DCB group and 3.5%in the DES group,with major adverse cardiovascular event(MACE)rate was 3.4%and 5.4%respectively.There were no significant differences between the two groups(P>0.05).Follow-up mild hemorrhagic events were lower in the DCB group than in the DES group(8%vs.18%,P<0.05).4.A total of 153 patients were followed up with angiography at an average of 11.7 months,there were 70 patients in DCB group and 83 patients in DES group.The residual stenosis of DCB group was higher than that of DES group immediately after operation(20.35±5.57%vs.12.90±5.65%,P<0.001),and the residual stenosis of follow-up was no significant differences between the two grops(23.52±13.77%vs.22.44±16.86%,P>0.05).The late lumen loss of DCB group was lower than that of DES group(0.08±0.38mm vs.0.25±0.32mm,P<0.05).ConclusionFor de novo lesions in coronary artery disease(exclude acute myocardial infarction,severe calcification,chronic occlusion lesions),the short-term effect of DCB therapy after full lesion preparations showed no inferiority compared with the DES.The late lumen loss of DCB was lower than that of DES group and the risk of mild hemorrhagic events is reduced.