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Clinical Outcomes in Percutaneous Coronary Intervention: Studies on Chronic Coronary Syndrome and Drug-Coated Balloons

von Koch, Sacharias LU orcid (2026) In Lund University, Faculty of Medicine Doctoral Dissertation Series
Abstract
Background: Percutaneous coronary intervention (PCI) is frequently used in the treatment of chronic coronary syndrome (CCS), although its impact on long-term prognosis and symptom relief remains debated. Among patients undergoing revascularisation with PCI, data on clinical outcomes following drug-coated balloon (DCB) based PCI in unselected patient populations is limited, and the comparative effectiveness of DCB- versus drug-eluting stents (DES) has not been fully established.

Methods: This thesis utilised data from Swedish national registries including the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Exclusion criteria, propensity score matching, and multivariable adjustment models were applied to mitigate... (More)
Background: Percutaneous coronary intervention (PCI) is frequently used in the treatment of chronic coronary syndrome (CCS), although its impact on long-term prognosis and symptom relief remains debated. Among patients undergoing revascularisation with PCI, data on clinical outcomes following drug-coated balloon (DCB) based PCI in unselected patient populations is limited, and the comparative effectiveness of DCB- versus drug-eluting stents (DES) has not been fully established.

Methods: This thesis utilised data from Swedish national registries including the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Exclusion criteria, propensity score matching, and multivariable adjustment models were applied to mitigate confounding.

Results: In paper I, PCI was associated with lower rates of 10-year all-cause mortality among patients with CCS. In paper II, revascularisation in patients with CCS with PCI or coronary artery bypass graft surgery was associated with a lower use of long-acting nitrates. In paper III, a DCB inflation time of ≥30 seconds was associated with lower 1-year rate of target segment revascularisation compared to <30 seconds. No difference was observed in Paper IV when paclitaxel-coated balloons were compared with sirolimus-coated balloons. In paper V, DES was associated with a lower rate of target vessel revascularisation compared to DCB in small non-complex de novo lesions. The use of DCB for in-stent restenosis was investigated in paper VI, DCB was associated lower rates of 5-year target lesion revascularisation compared to plain old balloon angioplasty, but an increased rate compared to DES.

Conclusions: In this thesis, which investigated outcome following PCI of CCS and PCI with DCB, PCI was associated with prognostic and symptomatic relief in CCS. A sufficient inflation time seems to be a prerequisite of DCB effectiveness, while specific drug type was not associated with any difference in outcome. The results support the continued role of DES as the standard of care in small-vessel disease and in-stent restenosis. (Less)
Abstract (Swedish)

Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Associate Professor Gao, Chao, Department of Cardiology, Xijing Hospital, Xi'an, China
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Drug-coated balloons, Chronic coronary syndrome, percutaneous coronary intervention, Swedish Coronary Angiography and Angioplasty Registry
in
Lund University, Faculty of Medicine Doctoral Dissertation Series
issue
2026:75
pages
84 pages
publisher
Lund University, Faculty of Medicine
defense location
Segerfalksalen, BMC A10, Sölvegatan 17 i Lund
defense date
2026-05-13 09:00:00
ISSN
1652-8220
ISBN
978-91-8021-873-3
language
English
LU publication?
yes
id
3709ea29-21a7-4ec1-8c31-76f46a3ee208
date added to LUP
2026-04-13 10:53:13
date last changed
2026-04-16 12:54:44
@phdthesis{3709ea29-21a7-4ec1-8c31-76f46a3ee208,
  abstract     = {{Background: Percutaneous coronary intervention (PCI) is frequently used in the treatment of chronic coronary syndrome (CCS), although its impact on long-term prognosis and symptom relief remains debated. Among patients undergoing revascularisation with PCI, data on clinical outcomes following drug-coated balloon (DCB) based PCI in unselected patient populations is limited, and the comparative effectiveness of DCB- versus drug-eluting stents (DES) has not been fully established.<br/><br/>Methods: This thesis utilised data from Swedish national registries including the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). Exclusion criteria, propensity score matching, and multivariable adjustment models were applied to mitigate confounding.<br/><br/>Results: In paper I, PCI was associated with lower rates of 10-year all-cause mortality among patients with CCS. In paper II, revascularisation in patients with CCS with PCI or coronary artery bypass graft surgery was associated with a lower use of long-acting nitrates. In paper III, a DCB inflation time of ≥30 seconds was associated with lower 1-year rate of target segment revascularisation compared to &lt;30 seconds. No difference was observed in Paper IV when paclitaxel-coated balloons were compared with sirolimus-coated balloons. In paper V, DES was associated with a lower rate of target vessel revascularisation compared to DCB in small non-complex de novo lesions. The use of DCB for in-stent restenosis was investigated in paper VI, DCB was associated lower rates of 5-year target lesion revascularisation compared to plain old balloon angioplasty, but an increased rate compared to DES.<br/><br/>Conclusions: In this thesis, which investigated outcome following PCI of CCS and PCI with DCB, PCI was associated with prognostic and symptomatic relief in CCS. A sufficient inflation time seems to be a prerequisite of DCB effectiveness, while specific drug type was not associated with any difference in outcome. The results support the continued role of DES as the standard of care in small-vessel disease and in-stent restenosis.}},
  author       = {{von Koch, Sacharias}},
  isbn         = {{978-91-8021-873-3}},
  issn         = {{1652-8220}},
  keywords     = {{Drug-coated balloons; Chronic coronary syndrome; percutaneous coronary intervention; Swedish Coronary Angiography and Angioplasty Registry}},
  language     = {{eng}},
  number       = {{2026:75}},
  publisher    = {{Lund University, Faculty of Medicine}},
  school       = {{Lund University}},
  series       = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
  title        = {{Clinical Outcomes in Percutaneous Coronary Intervention: Studies on Chronic Coronary Syndrome and Drug-Coated Balloons}},
  url          = {{https://lup.lub.lu.se/search/files/247324563/Avhandling_Sacharias_von_Koch_LUCRIS.pdf}},
  year         = {{2026}},
}