Clinical Outcomes of Drug‐Eluting Stents and Drug‐Coated Balloons in Tortuous Small Coronary Lesions
Shunichiro Ishio, Takashi Nagasaka, Ryota Taniuchi, Shiro Amanai, Yohei Ishibashi, Noriaki Takama, Hideki IshiiABSTRACT
Background
In small, tortuous coronary lesions, the long‐term comparative performance of drug‐coated balloon (DCB) angioplasty versus drug‐eluting stent (DES) treatment remains uncertain, despite both strategies being widely used in contemporary percutaneous coronary intervention (PCI) practice.
Aims
This study aimed to compare 3‐year clinical outcomes between DES and DCB in patients undergoing PCI for small, tortuous coronary lesions.
Methods
This retrospective, single‐center study included 366 patients treated with either DES ( n = 226) or DCB ( n = 140) for lesions with at least one angulation ≥ 45°. The primary endpoint was major adverse cardiac events (MACE). Time‐to‐event outcomes were assessed using Kaplan–Meier analysis and Cox proportional hazards models.
Results
Procedural success rates were high and comparable between groups. At 3 years, MACE occurred more frequently in the DCB group than in the DES group (log‐rank p = 0.013). In multivariable analysis, DCB use remained associated with higher risks of MACE (hazard ratio [HR] 1.88; 95% confidence interval [CI] 1.12–3.16; p = 0.017) and target vessel revascularization (TVR) (HR 1.84; 95% CI 1.01–3.21; p = 0.045). Subgroup analysis showed that DES had significantly better outcomes than DCB in lesions with mild‐to‐moderate tortuosity, whereas event rates were similar between groups in severely tortuous segments.
Conclusion
In small, tortuous coronary lesions, DES use was associated with lower rates of MACE and TVR at 3 years than DCB use. The advantage of DES was most apparent in mild‐to‐moderate tortuosity, whereas it was not statistically significant in severely tortuous vessels. These findings highlight the importance of anatomic complexity when selecting a treatment strategy for tortuous coronary lesions.