1
|
Khawaja M, Britt M, Rizwan A, Abraham J, Nguyen T, Munaf U, Khan MA, Arshad H, Munye M, Newman N, Ielasi A, Eccleshall S, Vassiliou VS, Merinopoulos I, Cortese B, Krittanawong C. Coronary Drug-Coated Balloons: A Comprehensive Review of Clinical Applications and Controversies. Trends Cardiovasc Med 2024:S1050-1738(24)00079-3. [PMID: 39243831 DOI: 10.1016/j.tcm.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 08/27/2024] [Accepted: 08/28/2024] [Indexed: 09/09/2024]
Abstract
Drug-coated balloons have emerged as a promising therapeutic option in the treatment of cardiovascular disease. This review article provides an overview of the concept of drug-coated balloons and their clinical applications in both de novo and treated coronary artery disease. A summary of key clinical trials and registry studies evaluating drug-coated balloons is presented for reference. Overall, this article aims to provide clinicians and researchers with a comprehensive understanding of the current state of drug-coated balloon technology and its implications in clinical practice.
Collapse
Affiliation(s)
- Muzamil Khawaja
- Department of Cardiology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Michael Britt
- Department of Internal Medicine, Emory University, Atlanta, GA, 30322, USA
| | - Affan Rizwan
- Department of Internal Medicine, The University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Jocelyn Abraham
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, 75390 USA
| | - Taylor Nguyen
- Division of Hospital Medicine, Northwestern Memorial Hospital; Chicago, IL, 60611
| | - Uzair Munaf
- Department of Internal Medicine, Dow Medical College, 75300, Karachi, Pakistan
| | - Muhammad Asad Khan
- Department of Family Medicine, West Chicago Immediate Care, West Chicago, IL, 60185-2847, USA
| | - Hassaan Arshad
- Department of Internal Medicine, Capital Health Regional Medical Centre, Trenton, NJ, 08638-4143, USA
| | - Muhamed Munye
- Department of Internal Medicine, Emory University, Atlanta, GA, 30322, USA
| | - Noah Newman
- Department of Internal Medicine, Emory University, Atlanta, GA, 30322, USA
| | - Alfonso Ielasi
- U.O. Cardiologia Ospedaliera, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Simon Eccleshall
- Department of Cardiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom
| | - Vassilios S Vassiliou
- Department of Cardiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom; Norfolk and Norwich University Hospital NHS Foundation Trust and University of East Anglia, Norwich
| | - Ioannis Merinopoulos
- Department of Cardiology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, United Kingdom; Norfolk and Norwich University Hospital NHS Foundation Trust and University of East Anglia, Norwich
| | | | - Chayakrit Krittanawong
- Department of Cardiology, NYU Langone Health and NYU School of Medicine, New York, NY, 10016, USA.
| |
Collapse
|
2
|
Cortese B, Sanchez-Jimenez E, Lazar L. Coronary stent failure: role of a blended approach with drug-coated balloons for complex lesions. Minerva Cardiol Angiol 2024; 72:266-280. [PMID: 36939731 DOI: 10.23736/s2724-5683.22.06172-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
The management of coronary artery disease by means of percutaneous approach have been focused initially to overcome the recoil and acute occlusion after vessel ballooning; therefore, to develop and improve metallic stent platforms, and later drug-eluting technologies. Contemporarily, the necessity emerged to optimize interventional procedures using functional physiologic tests and intravascular imaging guidance, but still stent failures, especially in the complex lesion setting, continue to be not negligible. This comprehensive review is focused on the technology of drug-coated balloons as a tool to treat coronary artery disease without the need for metal implantation but still eluting antirestenotic drugs such as paclitaxel or sirolimus. We delve into these technologies, the drugs, the technical aspects of the deployment and the most updated evidence also proposing a dedicated interventional algorithm. There is solid data to support the use of drug-coated balloons in patients with in-stent restenosis and de-novo small coronary artery disease but also new evidence with promising results from recent studies indicate the feasibility of this approach in complex coronary interventions, bifurcation lesions and larger coronary vessels. In this state-of-the-art review, we also propose a blended approach based on the combination of drug-eluting stents and drug-coated balloons, keeping in mind the necessity to reduce the total stent length in order to reduce the long-term risk of complications.
Collapse
Affiliation(s)
- Bernardo Cortese
- Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy -
| | | | - Leontin Lazar
- Fondazione Ricerca e Innovazione Cardiovascolare, Milan, Italy
| |
Collapse
|
3
|
Lu K, Ye X, Chen Y, Wang P, Gong M, Xuan B, Tang Z, Li M, Hou J, Peng K, Pei H. Research progress of drug eluting balloon in arterial circulatory system. Front Cardiovasc Med 2024; 11:1287852. [PMID: 38601040 PMCID: PMC11005962 DOI: 10.3389/fcvm.2024.1287852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 03/04/2024] [Indexed: 04/12/2024] Open
Abstract
The arterial circulatory system diseases are common in clinical practice, and their treatment options have been of great interest due to their high morbidity and mortality. Drug-eluting balloons, as a new type of endovascular interventional treatment option, can avoid the long-term implantation of metal stents and is a new type of angioplasty without stents, so drug-eluting balloons have better therapeutic effects in some arterial circulatory diseases and have been initially used in clinical practice. In this review, we first describe the development, process, and mechanism of drug-eluting balloons. Then we summarize the current studies on the application of drug-eluting balloons in coronary artery lesions, in-stent restenosis, and peripheral vascular disease. As well as the technical difficulties and complications in the application of drug-eluting balloons and possible management options, in order to provide ideas and help for future in-depth studies and provide new strategies for the treatment of more arterial system diseases.
Collapse
Affiliation(s)
- Keji Lu
- Department of Cardiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
- School of Medical and Life Sciences, Chengdu University of TCM, Chengdu, China
| | - Xianglin Ye
- Department of Cardiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Yaoxuan Chen
- School of Medical and Life Sciences, Chengdu University of TCM, Chengdu, China
| | - Peng Wang
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Meiting Gong
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Bing Xuan
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Zhaobing Tang
- Department of Rehabilitation, The General Hospital of Western Theater Command, Chengdu, China
| | - Meiling Li
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Jun Hou
- Department of Cardiology, Chengdu Third People's Hospital, Chengdu, China
| | - Ke Peng
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| | - Haifeng Pei
- Department of Cardiology, The Affiliated Hospital, Southwest Medical University, Luzhou, China
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, China
| |
Collapse
|
4
|
Sciahbasi A, Mazza TM, Pidone C, Samperi S, Cittadini E, Granatelli A. A New Frontier for Drug-Coated Balloons: Treatment of "De Novo" Stenosis in Large Vessel Coronary Artery Disease. J Clin Med 2024; 13:1320. [PMID: 38592181 PMCID: PMC10931954 DOI: 10.3390/jcm13051320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Drug-coated balloons (DCB) are a well-established option for treating in-stent restenosis endorsed by European Guidelines on myocardial revascularization. However, in recent years, a strategy of "leaving nothing behind" with DCB in de novo coronary stenosis has emerged as an appealing approach. Methods: We performed a systematic review to evaluate the current literature on the use of drug-coated balloons in the treatment of de novo stenosis in large vessel disease. Results: Observational studies, as well as randomized studies, demonstrated the safety of DCB percutaneous coronary interventions (PCI) in large vessel disease. The rate of major adverse cardiac events is even lower compared to drug-eluting stents in stable coronary artery disease. Conclusions: DCB PCI is feasible in large vessel disease, and future large, randomized studies are ongoing to confirm these results.
Collapse
Affiliation(s)
| | - Tiziano Maria Mazza
- Interventional Cardiology, Sandro Pertini Hospital-ASL RM2, 00157 Rome, Italy
| | - Chiara Pidone
- Interventional Cardiology, Sandro Pertini Hospital-ASL RM2, 00157 Rome, Italy
| | - Simona Samperi
- Interventional Cardiology, Sandro Pertini Hospital-ASL RM2, 00157 Rome, Italy
| | - Edoardo Cittadini
- Interventional Cardiology, Sandro Pertini Hospital-ASL RM2, 00157 Rome, Italy
| | - Antonino Granatelli
- Interventional Cardiology, Sandro Pertini Hospital-ASL RM2, 00157 Rome, Italy
| |
Collapse
|
5
|
Shan Y, Lu W, Han Z, Pan S, Li X, Wang X, Pan L, Wang X, Zheng X, Li R, Zhou Y, Qin P, Shi Q, Zhou S, Zhang W, Guo S, Qiu J, Zhang P, Qin X, Sun G, Qin Z, Huang Z, Qiu C. Long-term outcomes of drug-coated balloon treatment of calcified coronary artery lesions: a multicenter, retrospective, propensity matching study. Front Cardiovasc Med 2023; 10:1122290. [PMID: 37388642 PMCID: PMC10303933 DOI: 10.3389/fcvm.2023.1122290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/26/2023] [Indexed: 07/01/2023] Open
Abstract
Background Coronary artery calcification (CAC) is associated with high rates of restenosis and adverse clinical events after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Objectives The aim of this study was to evaluate the long-term clinical outcomes of drug-coated balloon (DCB)-only treatment for de novo lesions with and without CAC. Methods Patients with de novo coronary disease treated with the DCB-only strategy were retrospectively enrolled from three centers and categorized into a CAC group and a non-CAC group. The primary endpoint was the target lesion failure (TLF) rate during the 3-year follow-up. Secondary endpoints included the occurrence of major adverse cardiac events (MACEs), target lesion revascularization (TLR), cardiac death, myocardial infarction (MI) and any revascularization. Propensity score matching (PSM) was conducted to assemble a cohort of patients with similar baseline characteristics. Results A total of 1,263 patients with 1,392 lesions were included, and 243 patients were included in each group after PSM. Compared with the non-CAC group, the incidence rates of TLF (9.52% vs. 4.94%, odds ratio [OR]: 2.080; 95% confidence interval [CI]: 1.083-3.998, P = 0.034) and TLR (7.41% vs. 2.88%, OR: 2.642; 95% CI: 1.206-5.787, P = 0.020) in the CAC group were higher. The incidence rates of MACE (12.35% vs. 7.82%, OR: 1.665; 95% CI: 0.951-2.916, P = 0.079), cardiac death (2.06% vs. 2.06%, OR: 0.995; 95% CI: 0.288-3.436, P = 0.993), MI (1.23% vs. 0.82%, OR: 2.505; 95% CI: 0.261-8.689, P = 0.652) and any revascularization (12.76% vs. 9.67%, OR: 1.256; 95% CI: 0.747-2.111, P = 0.738) were similar between groups. Conclusions CAC increased the incidence of TLF and TLR without a substantial increase in the risk of MACE, cardiac death, MI, or any revascularization in patients treated with DCB-only angioplasty during the 3-year follow-up.
Collapse
Affiliation(s)
- Yingguang Shan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenjie Lu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhanying Han
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sancong Pan
- Department of Cardiovascular Medicine, Jincheng People’s Hospital, Jincheng, China
| | - Xiangbing Li
- Department of Cardiovascular Medicine, Jincheng People’s Hospital, Jincheng, China
| | - Xi Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liang Pan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xule Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaolin Zheng
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ran Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanjun Zhou
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peng Qin
- Department of Geriatric Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiangwei Shi
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuai Zhou
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wencai Zhang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sen Guo
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Qiu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peisheng Zhang
- Department of Cardiology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaofei Qin
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guoju Sun
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhongsheng Qin
- Department of Cardiovascular Medicine, Jincheng People’s Hospital, Jincheng, China
| | - Zhenwen Huang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chunguang Qiu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
6
|
Establishment of a Nomogram for Predicting the Suboptimal Angiographic Outcomes of Coronary De Novo Lesions Treated with Drug-Coated Balloons. Adv Ther 2023; 40:975-989. [PMID: 36583823 DOI: 10.1007/s12325-022-02400-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/01/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Factors affecting the angiographic outcomes of coronary de novo lesions treated with drug-coated balloons (DCBs) have not been well illustrated. The aim of the study is to establish a nomogram for predicting the risk of suboptimal diameter stenosis (DS) at angiographic follow-up. METHODS A retrospective analysis was performed on a cohort of patients who underwent DCB intervention for coronary de novo lesions with angiographic follow-up data. Multivariable logistic regression analysis was applied to determine the independent predictors of DS ≥ 30% at follow-up, and then a nomogram model was established and validated. RESULTS A total of 196 patients (313 lesions) were divided into the suboptimal (DS ≥ 30%) and optimal (DS < 30%) DS groups according to quantitative coronary angiography (QCA) measurements of the target lesions at follow-up. Seven independent factors including calcified lesions, true bifurcation lesions, immediate lumen gain rate (iLG%) < 20%, immediate diameter stenosis (iDS) ≥ 30%, DCB diameter/reference vessel diameter ratio (DCB/RVD) < 1.0, DCB length and mild dissection were identified. The area under the curve (AUC) (95% CI) of the receiver-operating characteristic (ROC) curve of the nomogram was 0.738 (0.683, 0.794). After the internal validation, the AUC (95% CI) was 0.740 (0.685, 0.795). The Hosmer-Lemeshow goodness of fit (GOF) test (χ2 = 6.57, P = 0.766) and the calibration curve suggested a good predictive consistency of the nomogram. CONCLUSIONS The well-calibrated nomogram could efficiently predict the suboptimal angiographic outcomes at follow-up. This model may be helpful to optimize lesion preparation to achieve optimal outcomes.
Collapse
|
7
|
Lin L, Lu W, Wang X, Pan L, Wang X, Zheng X, Li R, Shan Y, Peng M, Qiu C. Short-term outcomes of drug-coated balloon versus drug-eluting stent for de novo saphenous vein graft lesions in coronary heart disease. Front Cardiovasc Med 2023; 10:982880. [PMID: 36950290 PMCID: PMC10025469 DOI: 10.3389/fcvm.2023.982880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Abstract
Background As a device for percutaneous coronary intervention, drug-coated balloon (DCB) is widely used to treat in-stent restenosis. However, data regarding the use of DCB in treating de novo saphenous vein graft (SVG) lesions are limited. This study aimed to explore the outcomes of using the DCB in the treatment of de novo SVG lesions of coronary heart disease (CHD). Methods This retrospective and observational study analyzed CHD patients with de novo SVG lesions treated with DCB or the new-generation drug-eluting stent (DES) between January 2018 and December 2020. Restenosis was the primary endpoint, whereas target lesion revascularization (TLR), major adverse cardiac events, restenosis, cardiac death, target vessel revascularization, and myocardial infarction were the secondary outcomes. Results We enrolled 31 and 23 patients treated with DCB and DES, respectively. The baseline clinical data, lesion characteristics, and procedural characteristics were similar between the two groups. Twenty-eight (90.3%) patients in the DCB group and 21 (91.3%) in the DES group completed follow-up angiography after 1 year. The quantitative coronary angiography measurements at angiographic follow-up showing late lumen loss were -0.07 ± 0.95 mm for the DCB group and 0.86 ± 0.71 mm for the DES group (P = 0.039), and the rates of restenosis were 13.3% and 21.7% for the DCB and DES groups, respectively (P = 0.470). No significant differences were observed in the rates of MACE (16.7% vs. 26.1%, P = 0.402) and TLR (13.3% vs. 4.3%, P = 0.374) during clinical follow-up. Conclusion Our findings suggest that when pre-dilatation was successful, DCB might be safe and effective in treating de novo SVG lesions.
Collapse
|
8
|
Wang L, Li X, Li T, Liu L, Wang H, Wang C. Novel application of drug-coated balloons in coronary heart disease: A narrative review. Front Cardiovasc Med 2023; 10:1055274. [PMID: 36937937 PMCID: PMC10017483 DOI: 10.3389/fcvm.2023.1055274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
The incidence of coronary heart disease (CAD) has soared over the years, and coronary intervention has become an increasingly important therapeutic approach. The past decade has witnessed unprecedented developments in therapeutic medical instruments. Given that drug-coated balloons bring many benefits, they are indicated for an increasing number of conditions. In this article, we review the results of current clinical trials about drug-coated balloons and summarize their safety and clinical progression in different coronary artery diseases, laying the groundwork for basic research, and clinical therapeutics of this patient population.
Collapse
Affiliation(s)
- Lijin Wang
- Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiaokang Li
- Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Lin Liu
- Department of Dermatology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Haiyan Wang
- Department of Structural Heart Disease, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- *Correspondence: Haiyan Wang, ; Chiyao Wang,
| | - Chiyao Wang
- Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
- *Correspondence: Haiyan Wang, ; Chiyao Wang,
| |
Collapse
|
9
|
Anbalakan K, Toh HW, Ang HY, Buist ML, Leo HL. How does the Nature of an Excipient and an Atheroma Influence Drug-Coated Balloon Therapy? Cardiovasc Eng Technol 2022; 13:915-929. [PMID: 35606568 DOI: 10.1007/s13239-022-00626-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 04/19/2022] [Indexed: 01/27/2023]
Abstract
The advent of drug-eluting stents and drug-coated balloons have significantly improved the clinical outcome of patients with vascular occlusions. However, ischemic vascular disease remains the most common cause of death worldwide. Improving the current treatment modalities demands a better understanding of the processes which govern drug uptake and retention in blood vessels. In this study, we evaluated the influence of urea and butyryl-trihexyl citrate, as excipients, on the efficacy of drug-coated balloon therapy. An integrated approach, utilizing both in-vitro and in-silico methods, was used to quantify the tracking loss, vessel adhesion, drug release, uptake, and distribution associated with the treatment. Moreover, a parametric study was used to evaluate the potential influence of different types of lesions on drug-coated balloon therapy. Despite the significantly higher tracking loss (urea: 35.5% vs. butyryl-trihexyl citrate: 8.13%) observed in the urea-based balloons, the drug uptake was almost two times greater than with its hydrophobic counterpart. Non-calcified lesions were found to delay the transmural propagation of sirolimus while calcification was shown to limit the retentive potential of lesions. Ultimately this study helps to elucidate how different excipients and types of lesions may influence the efficacy of drug-coated balloon therapy.
Collapse
Affiliation(s)
- Karthic Anbalakan
- Department of Biomedical Engineering, National University of Singapore, Singapore, 117576, Singapore.
| | - Han Wei Toh
- National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, 169609, Singapore
| | - Hui Ying Ang
- Department of Biomedical Engineering, National University of Singapore, Singapore, 117576, Singapore.,National Heart Research Institute Singapore, National Heart Center Singapore, Singapore, 169609, Singapore.,Department of Cardiovascular & Metabolic Disorders, Duke-NUS Medical School, Singapore, 169857, Singapore
| | - Martin Lindsay Buist
- Department of Biomedical Engineering, National University of Singapore, Singapore, 117576, Singapore.
| | - Hwa Liang Leo
- Department of Biomedical Engineering, National University of Singapore, Singapore, 117576, Singapore.
| |
Collapse
|
10
|
Pan L, Lu W, Han Z, Pan S, Wang X, Shan Y, Peng M, Qin X, Sun G, Zhang P, Dong J, Qiu C. Drug-coated balloon in the treatment of coronary left main true bifurcation lesion: A patient-level propensity-matched analysis. Front Cardiovasc Med 2022; 9:1028007. [PMID: 36407423 PMCID: PMC9669294 DOI: 10.3389/fcvm.2022.1028007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Aims An increasing body of evidence suggests that drug-coated balloon (DCB) angioplasty represents a valuable option for revascularization in selected patients with coronary bifurcation disease. However, there remains a paucity of real-world observational evidence on the efficacy of DCB in left main (LM) true bifurcation lesion. We compared clinical and angiographic outcomes of hybrid [DCB + drug-eluting stent (DES)] versus DES-only strategy (provisional stenting or two-stent strategies) in de novo LM true bifurcated lesions. Methods The primary endpoint was the 2-year composite rate of target lesion failure (TLF): cardiac death, target vessel myocardial infarction (TVMI), or clinically driven target lesion revascularization (CD-TLR). A routine 1-year angiographic follow-up was scheduled. Propensity-score matching was utilized to assemble a cohort of patients with similar baseline characteristics. Results Among 1077 eligible patients, 199 who received DCB treatment and 398 who were assigned to DES therapy had similar propensity scores and were included in the analysis. TLF within 2 years occurred in 13 patients (7.56%) assigned to DCB group, and 52 patients (14.36%) assigned to DES group (odds ratio: 0.487; 95% confidence interval: 0.258–0.922; P = 0.025; Log-rank P = 0.024). Compared with the DES group, the DCB group resulted in a lower rate of CD-TLR (2.91% vs. 9.42%; P = 0.007). Cardiac death, TVMI, all-cause mortality, and stent thrombosis were comparable between both groups. Patients treated with DES-only were associated with a higher late lumen loss (0.42 ± 0.62 mm vs. 0.13 ± 0.42 mm, P < 0.001) compared with the DCB group at 1 year. In sensitivity analysis, the DCB group also presented a lower incidence of TLF, CD-TLR and stent thrombosis both compared to the two-stent strategy and compared to provisional stenting (Ps < 0.05). Conclusion The 2-year results of PCI utilizing DCB for LM true bifurcation lesions are superior to employing DES alone in terms of safety and effectiveness.
Collapse
Affiliation(s)
- Liang Pan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenjie Lu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhanying Han
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sancong Pan
- Department of Cardiology, Jincheng People’s Hospital, Jincheng, China
| | - Xi Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingguang Shan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Meng Peng
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaofei Qin
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guoju Sun
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peisheng Zhang
- Department of Cardiology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianzeng Dong
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Chunguang Qiu, ,
| | - Chunguang Qiu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Jianzeng Dong,
| |
Collapse
|
11
|
Yang X, Lu W, Pan L, Han Z, Pan S, Wang X, Zhu Y, Shan Y, Peng M, Qin P, Zhang P, Qin X, Sun G, Qin Z, Dong J, Qiu C. Long-term outcomes of drug-coated balloons in patients with diffuse coronary lesions. Front Cardiovasc Med 2022; 9:935263. [PMID: 36211569 PMCID: PMC9537625 DOI: 10.3389/fcvm.2022.935263] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundDrug-coated balloons (DCB), alone or in combination with drug-eluting stents (DES), may be used to treat diffuse coronary lesions. We aimed to explore the efficacy and safety of DCB in patients with diffuse coronary lesions.MethodsConsecutive patients with diffuse coronary lesions (lesion length > 25 mm) who underwent DCB and/or DES between January 2015 and December 2019 were included in this prospective, observational, multicenter study. The DCB group included 355 patients (360 lesions), of which 142 patients (143 lesions, 39.7%) received the DCB-only strategy and 213 patients (217 lesions, 60.3%) received the hybrid strategy (DCB combined with DES). The DES group included 672 patients (831 lesions) treated with DES alone. Target lesion revascularization (TLR) during 3-year follow-up was the primary outcome of interest. The secondary outcome was major adverse cardiac events (MACE), defined as a composite of all-cause death, non-fatal myocardial infarction, and target vessel revascularization.ResultsThe two groups had comparable baseline clinical and lesion characteristics. Lesion length was similar (43.52 ± 16.46 mm vs. 44.87 ± 15.80 mm, P = 0.181), but the stent length in the DCB group was significantly shorter (24.02 ± 23.62 mm vs. 51.89 ± 15.81 mm, P < 0.001). Ten lesions (2.8%) in the DCB group received bailout stents. Over 3 years of follow-up, no significant difference in TLR incidence between the groups (7.3 vs. 8.3%, log-rank P = 0.636) was observed. Incidence of MACE also did not differ significantly (11.3 vs. 13.7%, log-rank P = 0.324). No thrombosis events occurred in the DCB group, while four patients (0.6%) in the DES group experienced stent thrombosis (log-rank P = 0.193). Moreover, similar TLR and MACE rates were observed between DCB-only and hybrid strategies (TLR: 6.4 vs. 8.0%, log-rank P = 0.651; MACE: 11.4 vs. 11.2%, log-rank P = 0.884).ConclusionLong-term outcomes show that the efficacy and safety of the DCB strategy (DCB alone or combined with DES) are similar to those of DES alone in diffuse coronary lesions. These findings suggest that this strategy is a promising alternative for select patients with diffuse coronary lesions.
Collapse
Affiliation(s)
- Xinyue Yang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenjie Lu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Liang Pan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhanying Han
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sancong Pan
- Department of Cardiovascular Medicine, Jincheng People’s Hospital, Jincheng, China
| | - Xi Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yongjian Zhu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingguang Shan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Meng Peng
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peng Qin
- Department of Geriatric Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peisheng Zhang
- Department of Cardiology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaofei Qin
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Guoju Sun
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhongsheng Qin
- Department of Cardiovascular Medicine, Jincheng People’s Hospital, Jincheng, China
| | - Jianzeng Dong
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Jianzeng Dong,
| | - Chunguang Qiu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Chunguang Qiu,
| |
Collapse
|
12
|
Hu FW, Chang S, Li Q, Zhu YX, Wang XY, Cheng YW, Zhou QH, Liu B, Iqbal J, Tang XX, Zhang YJ. Long-Term Clinical Outcomes After Percutaneous Coronary Intervention With Drug-Coated Balloon-Only Strategy in de novo Lesions of Large Coronary Arteries. Front Cardiovasc Med 2022; 9:882303. [PMID: 35911516 PMCID: PMC9329593 DOI: 10.3389/fcvm.2022.882303] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Use of drug-coated balloon (DCB)-only strategy for revascularization of native large coronary artery lesions is on the rise. The long-term efficacy of this approach for bifurcation and non-bifurcation lesions remains unknown. We aim to assess the long-term clinical outcomes of DCB-only strategy for the treatment of de novo bifurcation and non-bifurcation lesions in large coronary arteries. Methods This multicenter, prospective, observational study enrolled 119 patients with de novo coronary lesions in vessels ≥2.75 mm. The primary end point was the rate of clinically driven target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization (TLR). Patients were followed up for a median of 2 years. Results Of 119 patients with 138 lesions, 66 patients (75 lesions) had bifurcation and 53 patients (63 lesions) had non-bifurcation lesions. Average reference vessel diameter was 3.1 ± 0.3 mm, and there was no difference in bifurcation and non-bifurcation group (3.0 ± 0.3 vs. 3.1 ± 0.3mm; p = 0.27). At 2-year follow-up, the TLF occurred in five (4.2%), TLR in four (3.4%), and target vessel revascularization (TVR) in five (4.2%) cases. The frequency of TLR and TVR was higher in the non-bifurcation group (p = 0.04 and 0.02, respectively), but there were no differences in TLF between the two groups (p = 0.17). The cumulative incidence of TLF (Kaplan-Meier estimates) was also not different in the two groups (log-rank p = 0.11). Conclusion DCB-only strategy for de novo lesions in large coronary arteries appears to be safe and effective for both bifurcation and non-bifurcation lesions. Further randomized clinical trials are warranted to confirm the value of DCB-only strategy in de novo bifurcation lesions of large vessels.
Collapse
Affiliation(s)
- Feng-Wang Hu
- Department of Cardiology, Xuzhou Third People’s Hospital, Xuzhou Medical University, Xuzhou, China
| | - Shang Chang
- Department of Cardiology, Xuzhou Third People’s Hospital, Xuzhou Medical University, Xuzhou, China
| | - Qian Li
- Department of Cardiology, Xuzhou Third People’s Hospital, Xuzhou Medical University, Xuzhou, China
| | - Yong-Xiang Zhu
- Department of Cardiology, Xuzhou Third People’s Hospital, Xuzhou Medical University, Xuzhou, China
| | - Xin-Yu Wang
- Department of Cardiology, Xuzhou Third People’s Hospital, Xuzhou Medical University, Xuzhou, China
| | - You-Wei Cheng
- Department of Cardiology, Xuzhou Third People’s Hospital, Xuzhou Medical University, Xuzhou, China
| | - Qi-Hua Zhou
- Department of Cardiology, Xuzhou Renci Hospital, Xuzhou, China
| | - Bing Liu
- Department of Cardiology, Peixian County Guotai Hospital, Xuzhou, China
| | - Javaid Iqbal
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Xiao-Xia Tang
- Department of Cardiology, Xuzhou Third People’s Hospital, Xuzhou Medical University, Xuzhou, China
| | - Yao-Jun Zhang
- Department of Cardiology, Xuzhou Third People’s Hospital, Xuzhou Medical University, Xuzhou, China
| |
Collapse
|
13
|
OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6517162. [DOI: 10.1093/ejcts/ezac036] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 11/15/2022] Open
|
14
|
Liu H, Zhao Y, Lu Y, Zhou S, Zhang Y, Zhao J, Yang H, Xing J, Feng R, Xue X, Tao H, Song R, Gu H. The Drug Coated Balloon-Only Strategy for Treatment of de Novo Left Main Coronary Artery Bifurcation Lesion: Stentless Strategy. Clin Appl Thromb Hemost 2022; 28:10760296221118489. [PMID: 35945818 PMCID: PMC9373168 DOI: 10.1177/10760296221118489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The study aimed to evaluate the efficacy and safety of drug coated balloon-only
strategy (DCB-only) in the treatment of de novo left main coronary artery (LM)
bifurcation lesions. 85 patients were enrolled in this study and classified them
into two groups: DCB-only group (n = 36) and DES group (n = 49). The MLD of
target vessels was measured before and immediately after percutaneous coronary
intervention (PCI) and late luminal loss (LLL) were also calculated. And the
occurrence of major adverse cardiovascular events (MACE) was also evaluated.
Compared with that before PCI, the MLD of target lesions significantly increased
immediately after PCI (P < .05) and no MACE was recorded
during the perioperative period both in two groups. The MLD at follow-up was
significantly higher than that before both DCB and DES treatment. Compared with
the DES group, the MLD of the DCB group was smaller than immediately after PCI
in the LM and LAD (P < .05). The LLL of LAD in DCB group was
smaller than that in DES group (P < .05). There was no
significant difference in the incidence of luminal restenosis at the target
lesion between the two groups, and no significant difference in the incidence of
MACE (P > .05). The use of DCB-only to treat de novo LM
bifurcation lesions is effective and relatively safe, which provides new ideas
for the treatment of LM coronary artery bifurcation lesions in the future.
Collapse
Affiliation(s)
- Hengdao Liu
- Department of Cardiology, 191599Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Yanyan Zhao
- Department of Cardiology, 191599Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Yang Lu
- Department of Emergency, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Shilong Zhou
- Department of Cardiology, 191599Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Yubin Zhang
- Department of Cardiology, 191599Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Junwei Zhao
- Department of Cardiology, Yexian People's Hospital, Pingdingshan, Henan, China
| | - Huilin Yang
- Department of Cardiology, Nanle people's Hospital, Puyang, Henan, China
| | - Junhui Xing
- Department of Cardiology, 191599Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Ruihan Feng
- Department of Cardiology, Xinxiang Central Hospital, Xinxiang, Henan, China
| | - XiaoFei Xue
- Department of Cardiology, 191599Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Hailong Tao
- Department of Cardiology, 191599Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Ruipeng Song
- Department of Endocrinology, The Third People's Provincial Hospital of Henan Province, Zhengzhou, Henan, China
| | - Heping Gu
- Department of Cardiology, 191599Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| |
Collapse
|
15
|
Zhang Y, Zhang X, Dong Q, Chen D, Xu Y, Jiang J. Duration of Dual Antiplatelet Therapy After Implantation of Drug-Coated Balloon. Front Cardiovasc Med 2021; 8:762391. [PMID: 34926613 PMCID: PMC8671702 DOI: 10.3389/fcvm.2021.762391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/08/2021] [Indexed: 12/28/2022] Open
Abstract
The drug-coated balloon (DCB) is an emerging percutaneous coronary intervention (PCI) device with theoretical advantages and promising results. Recent clinical observations have demonstrated that DCB tends to have both good efficacy and a good safety profile in the treatment of in-stent restenosis (ISR) for both bare-metal and drug-eluting stents (DES), de novo coronary artery disease (CAD), and other situation, such as high bleeding risk, chronic total occlusion, and acute coronary syndrome (ACS). Dual antiplatelet therapy (DAPT) has become an essential medication in daily clinical practice, but the optimal duration of DAPT after the implantation of a DCB remains unknown. At the time of the first in vivo implantation of paclitaxel-DCB for the treatment of ISR in 2006, the protocol-defined DAPT duration was only 1 month. Subsequently, DAPT duration ranging from 1 to 12 months has been recommended by various trials. However, there have been no randomized controlled trials (RCTs) on the optimal duration of DAPT after DCB angioplasty. Current clinical guidelines normally recommend the duration of DAPT after DCB-only angioplasty based on data from RCTs on the optimal duration of DAPT after stenting. In this review, we summarized current clinical trials on DCB-only angioplasty for different types of CADs and their stipulated durations of DAPT, and compared their clinical results such as restenosis, target lesion revascularization (TLR) and stent thrombosis event. We hope this review can assist clinicians in making reasonable decisions about the duration of DAPT after DCB implantation.
Collapse
Affiliation(s)
- Yuxuan Zhang
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xinyi Zhang
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qichao Dong
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Delong Chen
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yi Xu
- Department of Cardiology, Ningbo First Hospital, Ningbo, China
| | - Jun Jiang
- Department of Cardiology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
16
|
Her AY, Yuan SL, Jun EJ, Bhak Y, Kim MH, Garg S, Kim YH, Kun L, Hui L, Zhi W, Hao J, Zhentao S, Qiang T, Shin ES. Drug-coated balloon treatment for nonsmall de-novo coronary artery disease: angiographic and clinical outcomes. Coron Artery Dis 2021; 32:534-540. [PMID: 33471480 DOI: 10.1097/mca.0000000000001006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Although drug-coated balloons (DCBs) are established for de-novo lesions in small coronary arteries, the impact of DCB treatment according to the reference vessel diameter (RVD) remains poorly defined. This study aimed to evaluate the angiographic and long-term clinical outcomes of DCB treatment for de-novo coronary lesions according to RVD. METHODS AND RESULTS A total of 227 patients were retrospectively enrolled and stratified according to an RVD >2.5 mm [nonsmall vessel disease (NSVD) group, n = 100] and ≤2.5 mm [small vessel disease (SVD) group, n = 127]. The primary endpoint was late lumen loss (LLL) at a 6-month follow-up, and the secondary endpoint was target vessel failure (TVF, a composite of cardiac death, target vessel myocardial infarction, target vessel revascularization and target vessel thrombosis). The LLL among the 206 patients (90.8%) returning for scheduled angiography at 6 month was similar (NSVD, 0.03 ± 0.22 mm vs. SVD, 0.06 ± 0.25 mm; P = 0.384). TVF was also comparable in both groups at a median follow-up of 3.4 years (NSVD, 7.0 vs. SVD, 7.9 %; P = 0.596). At baseline, there were numerically more dissections in the SVD group compared to the NSVD group (47.2 vs. 35.0 %; P = 0.064); however, most of these had disappeared in both groups at a 6-month follow-up. In a multivariable analysis, the presence of dissection was not associated with LLL or TVF in either group. CONCLUSIONS The safety and efficacy of DCB treatment for de-novo coronary lesions, in terms of LLL and TVF, was unrelated to RVD.
Collapse
Affiliation(s)
- Ae-Young Her
- Department of Internal Medicine, Division of Cardiology, Kangwon National University School of Medicine, Chuncheon
| | - Song Lin Yuan
- Department of Cardiology, Ulsan Medical Center, Ulsan
- Department of Cardiology, Dong-A University Hospital, Busan
| | - Eun Jung Jun
- Department of Cardiology, Ulsan Medical Center, Ulsan
| | - Youngjune Bhak
- Korean Genomics Center, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Hospital, Busan
| | - Scot Garg
- East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, UK
| | - Yong Hoon Kim
- Department of Internal Medicine, Division of Cardiology, Kangwon National University School of Medicine, Chuncheon
| | - Liu Kun
- Department of Cardiology, Peking University Shougang Hospital, Peking, China
| | - Lin Hui
- Department of Cardiology, Peking University Shougang Hospital, Peking, China
| | - Wang Zhi
- Department of Cardiology, Peking University Shougang Hospital, Peking, China
| | - Jiang Hao
- Department of Cardiology, Peking University Shougang Hospital, Peking, China
| | - Shi Zhentao
- Department of Cardiology, Peking University Shougang Hospital, Peking, China
| | - Tang Qiang
- Department of Cardiology, Peking University Shougang Hospital, Peking, China
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan Medical Center, Ulsan
- Heart Research Institute, Chung-Ang University, Seoul, South Korea
| |
Collapse
|
17
|
Pan L, Lu W, Han Z, Pan S, Wang X, Shan Y, Wang X, Zheng X, Li R, Zhou Y, Qin P, Shi Q, Zhou S, Zhang W, Guo S, Zhang P, Qin X, Sun G, Qin Z, Huang Z, Qiu C. Clinical Outcomes of Drug-Coated Balloon in Coronary Patients with and without Diabetes Mellitus: A Multicenter, Propensity Score Study. J Diabetes Res 2021; 2021:5495219. [PMID: 34368364 PMCID: PMC8342102 DOI: 10.1155/2021/5495219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/15/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Relative to nondiabetic patients, percutaneous coronary intervention (PCI) in patients with diabetes mellitus (DM) is associated with inferior clinical outcomes. We aimed to evaluate the outcomes of drug-coated balloon (DCB) in diabetic versus nondiabetic patients. METHODS AND RESULTS In this observational, prospective, multicenter study, we compared the outcomes of patients with and without DM after undergoing PCI with DCBs. Target lesion failure (TLF) was analyzed as primary endpoint. Secondary endpoints were the rates of target lesion revascularization (TLR), major adverse cardiovascular events (MACE), cardiac death, myocardial infarction (MI), and any revascularization. Propensity score matching was used to assemble a cohort of patients with similar baseline characteristics. Among 2,306 eligible patients, 578 with DM and 578 without DM had similar propensity scores and were included in the analyses. During follow-up (366 ± 46 days), compared with DM patients, patients without DM were associated with a lower yearly incidence of TLF (2.77% vs. 5.36%; OR, 1.991; 95% CI, 1.077 to 3.681; P = 0.025) and TLR (1.90% vs. 4.15%; OR, 2.233; 95% CI, 1.083 to 4.602; P = 0.026). No significant differences were observed with regards to rates of MACE (OR: 1.580, 95% CI: 0.912-2.735; P = 0.100), cardiac death (OR: 1.608, 95% CI: 0.523-4.946; P = 0.403), MI (OR: 4.042, 95% CI: 0.855-19.117; P = 0.057), and any revascularization (OR: 1.534, 95% CI: 0.983-2.393; P = 0.058). CONCLUSIONS Diabetic patients experience higher TLF and TLR rates following DCB angioplasty without substantial increase in the risk of MACE, cardiac death, MI, or revascularization.
Collapse
Affiliation(s)
- Liang Pan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, China
| | - Wenjie Lu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, China
| | - Zhanying Han
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, China
| | - Sancong Pan
- Department of Cardiovascular Medicine, Jincheng People's Hospital, China
| | - Xi Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, China
| | - Yingguang Shan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, China
| | - Xule Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, China
| | - Xiaolin Zheng
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, China
| | - Ran Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, China
| | - Yanjun Zhou
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, China
| | - Peng Qin
- Department of Geriatric Cardiology, The First Affiliated Hospital of Zhengzhou University, China
| | - Qiangwei Shi
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, China
| | - Shuai Zhou
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, China
| | - Wencai Zhang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, China
| | - Sen Guo
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, China
| | - Peisheng Zhang
- Department of Cardiology, The Fifth Affiliated Hospital of Zhengzhou University, China
| | - Xiaofei Qin
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, China
| | - Guoju Sun
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, China
| | - Zhongsheng Qin
- Department of Cardiovascular Medicine, Jincheng People's Hospital, China
| | - Zhenwen Huang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, China
| | - Chunguang Qiu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, China
| |
Collapse
|
18
|
Pan L, Lu W, Han Z, Pan S, Wang X, Shan Y, Wang X, Zheng X, Li R, Zhou Y, Qin P, Shi Q, Zhou S, Zhang W, Guo S, Zhang P, Qin X, Sun G, Qin Z, Huang Z, Qiu C. Clinical outcomes of drug-coated balloon in coronary lesions: a real-world, all-comers study. Clin Res Cardiol 2021; 111:732-741. [PMID: 34313800 DOI: 10.1007/s00392-021-01895-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/10/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUNDS Although drug-eluting stents are the most common interventional devices for patients with coronary disease, drug-coated balloons (DCBs) represent a novel therapeutic alternative in certain scenarios. This prospective, observational all-comers study explored the clinical outcomes of DCB use in patients with coronary lesions. METHODS AND RESULTS All patients treated with DCBs were enrolled in this study, including patients with in-stent restenosis (ISR) or de novo lesions. The primary outcome was the target lesion revascularization (TLR) rate at one year. We enrolled 2306 patients with 2660 lesions and performed DCB angioplasty in 399 patients (17.3%) with ISR and 1907 patients (82.7%) with de novo lesions. During follow-up (366 ± 46 days), the TLR rate was lower in the de novo lesion group (1.31%) compared to the ISR group (7.02%) [odds ratio (OR) 0.176, 95% confidence interval (CI) 0.101-0.305, p < 0.001]. Patients with de novo lesions had a lower yearly incidence of MACE compared to ISR patients (2.73 vs. 9.27%, respectively, OR 0.274, 95% CI 0.177-0.424, p < 0.001) and a lower incidence of any revascularization (5.09 vs. 13.03%, OR 0.358, 95% CI 0.251-0.510, p < 0.001). No significant differences between groups were observed in the rates of cardiac death (OR 0.783, 95% CI 0.258-2.371, p = 0.655) or MI (OR 0.696, 95% CI 0.191-2.540, p = 0.573). CONCLUSIONS DCB angioplasty in this all-comers, real-world, prospective study was safe and efficient with low TLR and MACE rates. Thus, DCB appears to be an attractive alternative for the stent-less treatment of de novo coronary lesions. ISR in-stent restenosis; OR odds ratio; CI confidence interval; TLR target lesion revascularization; MACE major adverse cardiovascular events; MI myocardial infraction. MACE defined as the composite outcome of cardiac death, myocardial infarction, and target vessel revascularization. Any revascularization includes any percutaneous coronary intervention, and coronary artery bypass grafting.
Collapse
Affiliation(s)
- Liang Pan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, Henan, China
| | - Wenjie Lu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, Henan, China
| | - Zhanying Han
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, Henan, China
| | - Sancong Pan
- Department of Cardiovascular Medicine, Jincheng People's Hospital, No. 456, Wenchang East Road, Jincheng, Shanxi, China
| | - Xi Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, Henan, China
| | - Yingguang Shan
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, Henan, China
| | - Xule Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, Henan, China
| | - Xiaolin Zheng
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, Henan, China
| | - Ran Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, Henan, China
| | - Yanjun Zhou
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, Henan, China
| | - Peng Qin
- Department of Geriatric Cardiology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, Henan, China
| | - Qiangwei Shi
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, Henan, China
| | - Shuai Zhou
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, Henan, China
| | - Wencai Zhang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, Henan, China
| | - Sen Guo
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, Henan, China
| | - Peisheng Zhang
- Department of Cardiology, The Fifth Affiliated Hospital of Zhengzhou University, No. 3, Kangfu Qianjie, Zhengzhou, Henan, China
| | - Xiaofei Qin
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, Henan, China
| | - Guoju Sun
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, Henan, China
| | - Zhongsheng Qin
- Department of Cardiovascular Medicine, Jincheng People's Hospital, No. 456, Wenchang East Road, Jincheng, Shanxi, China
| | - Zhenwen Huang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, Henan, China
| | - Chunguang Qiu
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Zhengzhou, Henan, China.
| |
Collapse
|
19
|
Yu X, Wang X, Ji F, Zhang W, Yang C, Xu F, Wang F. A Non-inferiority, Randomized Clinical Trial Comparing Paclitaxel-Coated Balloon Versus New-Generation Drug-Eluting Stents on Angiographic Outcomes for Coronary De Novo Lesions. Cardiovasc Drugs Ther 2021; 36:655-664. [PMID: 33713211 PMCID: PMC9270292 DOI: 10.1007/s10557-021-07172-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 11/24/2022]
Abstract
Background Drug-coated balloon (DCB) has been proved efficacy for coronary small vessel disease, but data regarding outcomes of DCB in common de novo lesions (including reference vessel diameter more than 3.0mm) compared with new-generation drug-eluting stent (DES) are lacking. We hypothesized that a DCB-only strategy for coronary de novo lesions would be non-inferior to DES treatment on angiographic outcomes. Methods In this randomized controlled trial, we compared the effect of DCB with DES on late lumen loss (LLL) at 9-month angiographic follow-up and 12-month major adverse cardiac events (MACEs), including death, non-fatal myocardial infarction, target lesion revascularization (TLR), and target vessel revascularization (TVR). Results From July 2017 to July 2018, 288 consecutive patients with reference vessel diameter (RVD) between 2.25 and 4.0mm were screened. After proper pre-dilation, 170 patients were enrolled and randomized to the DCB and the DES groups at 1:1 ratio. Seven patients withdrew the consent forms during hospital stay (1 in DCB group, 6 in DES group). Two patients in DCB group underwent bailout stenting due to severe dissection after DCB release. The primary endpoint of 9-month LLL was −0.19±0.49mm with the DCB versus 0.03±0.64mm with the DES. The one-sided 97.5% upper confidence limit of the difference was −0.04mm, achieving non-inferiority of the DCB compared with the DES (P=0.019). The 12-month cumulative MACE rate was similar in the DCB and DES groups (2.44% vs. 6.33%, P=0.226). Conclusions In this prospective study, the DCB only strategy for de novo lesion was non-inferior to the new-generation DES in terms of 9-month late lumen loss. Supplementary Information The online version contains supplementary material available at 10.1007/s10557-021-07172-4.
Collapse
Affiliation(s)
- Xue Yu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730, Beijing, P. R. China
| | - Xinyue Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730, Beijing, P. R. China
| | - Fusui Ji
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730, Beijing, P. R. China.
| | - Wenduo Zhang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730, Beijing, P. R. China
| | - Chenguang Yang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730, Beijing, P. R. China
| | - Feng Xu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730, Beijing, P. R. China
| | - Fang Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100730, Beijing, P. R. China
| |
Collapse
|
20
|
Anbalakan K, Toh HW, Ang HY, Buist ML, Leo HL. Assessing the influence of atherosclerosis on drug coated balloon therapy using computational modelling. Eur J Pharm Biopharm 2020; 158:72-82. [PMID: 33075477 DOI: 10.1016/j.ejpb.2020.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/11/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
Interventional therapies such as drug-eluting stents (DES) and drug-coated balloons (DCB) have significantly improved the clinical outcomes of patients with coronary occlusions in recent years. Despite this marked improvement, ischemic cardiovascular disease remains the most common cause of death worldwide. To address this, research efforts are focused on improving the safety and efficacy of the next generation of these devices. However, current experimental methods are unable to account for the influence of atherosclerotic lesions on drug uptake and retention. Therefore, in this study, we used an integrated approach utilizing both in vitro and in silico methods to assess the performance of DCB therapy. This approach was validated against existing in vivo results before being used to numerically estimate the effect of the atheroma. A bolus release of sirolimus was observed with our coating matrix. This, coupled with the rapid saturation of specific and non-specific binding sites observed in our study, indicated that increasing the therapeutic dose coated onto the balloons might not necessarily result in greater uptake and/or retention. Additionally, our findings alluded to an optimal exposure time, dependent on the coating matrix, for the DCBs to be expanded against the vessel. Moreover, our findings suggest that a biphasic drug release profile might be beneficial for establishing and maintaining the saturation of bindings sites within severely occluded vessels. Ultimately, we have demonstrated that computational methods may be capable of assessing the efficacy of DCB therapy as well as predict the influence of atherosclerotic lesions on said efficacy.
Collapse
Affiliation(s)
- Karthic Anbalakan
- Department of Biomedical Engineering, National University of Singapore, Singapore 117576, Singapore.
| | - Han Wei Toh
- Department of Biomedical Engineering, National University of Singapore, Singapore 117576, Singapore; National Heart Research Institute Singapore, National Heart Center Singapore 169609, Singapore
| | - Hui Ying Ang
- Department of Biomedical Engineering, National University of Singapore, Singapore 117576, Singapore; National Heart Research Institute Singapore, National Heart Center Singapore 169609, Singapore
| | - Martin Lindsay Buist
- Department of Biomedical Engineering, National University of Singapore, Singapore 117576, Singapore.
| | - Hwa Liang Leo
- Department of Biomedical Engineering, National University of Singapore, Singapore 117576, Singapore.
| |
Collapse
|
21
|
Lin Y, Sun X, Liu H, Pang X, Dong S. Drug-coated balloon versus drug-eluting stent for treating de novo coronary lesions in large vessels: a meta-analysis of clinical trials. Herz 2020; 46:269-276. [PMID: 32468141 DOI: 10.1007/s00059-020-04938-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 03/30/2020] [Accepted: 05/04/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Studies examining the efficiency of drug-coated balloon (DCB) compared to drug-eluting stents (DES) for de novo lesions in large vessels have reported inconsistent results. OBJECTIVE This comprehensive meta-analysis of clinical trials compared the efficacy and safety of DCB and DES for the treatment of de novo coronary lesions. METHODS The authors formally searched electronic databases before October 2019 to identify randomized and non-randomized clinical trials (RCTs and non-RCTs, respectively). Clinical trials were eligible for inclusion if they compared DCB with DES in patients with coronary lumen diameters >2.5 mm. RESULTS Three RCTs and one non-RCT with a total of 321 patients were included in our meta-analysis (DCB group = 152, DES group = 169). The primary endpoint was in-segment late lumen loss (LLL) with a standardized mean difference (SMD) of -0.07 (95% confidence interval [CI]: -0.31, 0.316; P = 0.548) and the secondary endpoint was target lesion revascularization (TLR) with a risk ratio (RR) of 1.17 (95% CI: 0.46, 2.95; P = 0.746). CONCLUSION This meta-analysis indicated that DCB might be non-inferior to DES as evidenced by quantitative coronary angiography (QCA) assessed at 6-9 months after percutaneous coronary intervention in patients presenting with coronary artery disease.
Collapse
Affiliation(s)
- Yaowang Lin
- Department of Cardiology, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, first affiliated Hospital of South University of Science and Technology, No. 1017, Dongmen Northern Road, 518020, Shenzhen, Guangdong, China
| | - Xin Sun
- Department of Cardiology, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, first affiliated Hospital of South University of Science and Technology, No. 1017, Dongmen Northern Road, 518020, Shenzhen, Guangdong, China
| | - Huadong Liu
- Department of Cardiology, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, first affiliated Hospital of South University of Science and Technology, No. 1017, Dongmen Northern Road, 518020, Shenzhen, Guangdong, China
| | - Xinli Pang
- Department of Cardiology, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, first affiliated Hospital of South University of Science and Technology, No. 1017, Dongmen Northern Road, 518020, Shenzhen, Guangdong, China
| | - Shaohong Dong
- Department of Cardiology, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, first affiliated Hospital of South University of Science and Technology, No. 1017, Dongmen Northern Road, 518020, Shenzhen, Guangdong, China.
| |
Collapse
|