Use of drug-coated balloon-only strategy for treating de novo left main coronary artery disease

Researchers at North Karelia Central Hospital-Heart Center, Finland, conducted a retrospective single-center registry study that focused on the use of drug-coated balloon (DCB)-only strategy for treating de novo left main coronary artery disease. The study, published in Frontiers of Medicine, is significant as it addresses a treatment approach that has not been extensively studied before, particularly in the context of high bleeding risk (HBR) patients.

The study included all consecutive patients who underwent percutaneous coronary intervention (PCI) for a de novo left main coronary artery lesion using the DCB-only strategy between August 2011 and December 2018. The primary endpoint was major adverse cardiovascular events (MACEs) including cardiac death, non-fatal myocardial infarction, and target lesion revascularization (TLR). The cohort was divided into two groups based on whether the lesion preparation was done according to the international consensus group guidelines.

The study included 66 patients with a mean age of 75±8.6 years, and 72% were male. Acute coronary syndrome was present in 52% of the patients. No procedural mortality and no acute closures of the treated left main occurred. At 12 months, MACE and TLR occurred in 24% and 6% of the whole cohort, respectively. If the lesion preparation was done according to the guidelines, the MACE and TLR rates were significantly lower at 21.2% and 1.9%. The study concluded that left main PCI with the DCB-only strategy is safe and leads to acceptable MACE and low TLR rates at one year if the lesion preparation is done according to the guidelines.

The study highlights the importance of proper lesion preparation in the DCB-only strategy for de novo left main coronary artery disease. It also emphasizes the potential benefits of this approach, especially in HBR patients, where the DCB-only strategy may enable a shorter duration of dual antiplatelet therapy (DAPT) or even no DAPT at all, reducing the risk of bleeding complications.

The limitations of the study include its retrospective nature, the relatively small number of patients, and the overrepresentation of HBR, elderly, and patients with calcified complex left main lesions.

Despite these limitations, the study provides valuable insights into the DCB-only strategy for left main coronary artery disease and suggests that with proper lesion preparation, this approach could be a viable option for HBR patients.

The article is a significant contribution to the field of interventional cardiology, particularly for clinicians and researchers interested in PCI strategies for left main coronary artery disease and the management of HBR patients.

It calls for future randomized trials comparing DCB angioplasty to stenting with drug-eluting stents (DESs) to confirm these results and further explore the potential benefits and limitations of the DCB-only strategy.

More information:
Sanna Uskela et al, Drug-coated balloon-only strategy for percutaneous coronary intervention of de novo left main coronary artery disease: the importance of proper lesion preparation, Frontiers of Medicine (2022). DOI: 10.1007/s11684-022-0950-1

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