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Drug-Coated Balloons Versus Drug-Eluting Stents or Plain Old Balloon Angioplasty : A Long-Term in-Stent Restenosis Study

von Koch, Sacharias LU orcid ; Zhou, Mikael LU ; Rosén, Hans Christian LU orcid ; Zwackman, Sammy ; Jurga, Juliane ; Grimfjärd, Per ; Götberg, Matthias LU ; Mohammad, Moman A. LU orcid and Erlinge, David LU orcid (2024) In Journal of the American Heart Association 13(23).
Abstract

BACKGROUND: Balloon angioplasty with drug-coated balloons (DCBs) is frequently used during percutaneous coronary intervention for in-stent restenosis. Despite its frequent use, there is a lack of long-term data on the efficacy of DCB angioplasty. We conducted an investigation on the long-term efficacy outcome of in-stent restenosis, comparing DCBs, drug-eluting stents, and plain old balloon angioplasty. METHODS AND RESULTS: We conducted a nationwide analysis from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) including in-stent restenosis lesions undergoing coronary angiography between June 11, 2013, and January 14, 2022. The primary outcome of this study was target-lesion revascularization within a 5-year follow-up.... (More)

BACKGROUND: Balloon angioplasty with drug-coated balloons (DCBs) is frequently used during percutaneous coronary intervention for in-stent restenosis. Despite its frequent use, there is a lack of long-term data on the efficacy of DCB angioplasty. We conducted an investigation on the long-term efficacy outcome of in-stent restenosis, comparing DCBs, drug-eluting stents, and plain old balloon angioplasty. METHODS AND RESULTS: We conducted a nationwide analysis from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) including in-stent restenosis lesions undergoing coronary angiography between June 11, 2013, and January 14, 2022. The primary outcome of this study was target-lesion revascularization within a 5-year follow-up. Secondary outcomes included all-cause death, cardiovascular death, myocardial infarction, and any percutaneous coronary intervention. The outcomes were analyzed using a multivariable Cox proportional hazard model or Poisson regression, as appropriate. A total of 10 561 lesions from 9062 patients were included. Compared with plain old balloon angioplasty, the use of DCB angioplasty was associated with less target-lesion revascularization (risk ratio, 0.69 [95% CI, 0.57–0.82]), all-cause death (risk ratio, 0.72 [95% CI, 0.59–0.88]), and cardiovascular death (hazard ratio [HR], 0.59 [95% CI, 0.45–0.78]). No difference was observed for myocardial infarction or any percutaneous coronary intervention. Compared with drug-eluting stents, the use of DCBs was associated with higher rates of target-lesion revascularization (HR, 1.20 [95% CI, 1.06–1.37]). No difference was observed for all-cause death, cardiovascular death, myocardial infarction, or any percutaneous coronary intervention. CONCLUSIONS: In this long-term nationwide analysis, the use of DCB angioplasty showed superior outcomes compared with plain old balloon angioplasty within 5 years but higher rates of repeat revascularizations compared with drug-eluting stents.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
drug-coated balloon, drug-eluting stent, in-stent restenosis, plain old balloon angioplasty, target-lesion revascularization
in
Journal of the American Heart Association
volume
13
issue
23
article number
e036839
publisher
Wiley-Blackwell
external identifiers
  • scopus:85211660276
  • pmid:39575722
ISSN
2047-9980
DOI
10.1161/JAHA.124.036839
language
English
LU publication?
yes
id
f217ea90-34b0-4f79-b294-0eb70e9d6d35
date added to LUP
2025-01-20 12:46:32
date last changed
2025-07-08 13:22:45
@article{f217ea90-34b0-4f79-b294-0eb70e9d6d35,
  abstract     = {{<p>BACKGROUND: Balloon angioplasty with drug-coated balloons (DCBs) is frequently used during percutaneous coronary intervention for in-stent restenosis. Despite its frequent use, there is a lack of long-term data on the efficacy of DCB angioplasty. We conducted an investigation on the long-term efficacy outcome of in-stent restenosis, comparing DCBs, drug-eluting stents, and plain old balloon angioplasty. METHODS AND RESULTS: We conducted a nationwide analysis from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) including in-stent restenosis lesions undergoing coronary angiography between June 11, 2013, and January 14, 2022. The primary outcome of this study was target-lesion revascularization within a 5-year follow-up. Secondary outcomes included all-cause death, cardiovascular death, myocardial infarction, and any percutaneous coronary intervention. The outcomes were analyzed using a multivariable Cox proportional hazard model or Poisson regression, as appropriate. A total of 10 561 lesions from 9062 patients were included. Compared with plain old balloon angioplasty, the use of DCB angioplasty was associated with less target-lesion revascularization (risk ratio, 0.69 [95% CI, 0.57–0.82]), all-cause death (risk ratio, 0.72 [95% CI, 0.59–0.88]), and cardiovascular death (hazard ratio [HR], 0.59 [95% CI, 0.45–0.78]). No difference was observed for myocardial infarction or any percutaneous coronary intervention. Compared with drug-eluting stents, the use of DCBs was associated with higher rates of target-lesion revascularization (HR, 1.20 [95% CI, 1.06–1.37]). No difference was observed for all-cause death, cardiovascular death, myocardial infarction, or any percutaneous coronary intervention. CONCLUSIONS: In this long-term nationwide analysis, the use of DCB angioplasty showed superior outcomes compared with plain old balloon angioplasty within 5 years but higher rates of repeat revascularizations compared with drug-eluting stents.</p>}},
  author       = {{von Koch, Sacharias and Zhou, Mikael and Rosén, Hans Christian and Zwackman, Sammy and Jurga, Juliane and Grimfjärd, Per and Götberg, Matthias and Mohammad, Moman A. and Erlinge, David}},
  issn         = {{2047-9980}},
  keywords     = {{drug-coated balloon; drug-eluting stent; in-stent restenosis; plain old balloon angioplasty; target-lesion revascularization}},
  language     = {{eng}},
  number       = {{23}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of the American Heart Association}},
  title        = {{Drug-Coated Balloons Versus Drug-Eluting Stents or Plain Old Balloon Angioplasty : A Long-Term in-Stent Restenosis Study}},
  url          = {{http://dx.doi.org/10.1161/JAHA.124.036839}},
  doi          = {{10.1161/JAHA.124.036839}},
  volume       = {{13}},
  year         = {{2024}},
}