Drug-Coated Balloons Versus Drug-Eluting Stents Following Coronary Atherectomy in Severely Calcified Lesions: A Systematic Review and Meta-analysis.
Ricardo F O Suruagy-Motta, Leonardo Dexheimer da Silva, Caio Rodrigues Rosa et al.
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In 30 seconds
This systematic review and meta-analysis compared drug-coated balloons (DCB) with drug-eluting stents (DES) after atherectomy for severely calcified coronary lesions. It included eight observational studies with 1,968 patients. Pooled analyses found no statistically significant differences in major adverse cardiovascular events, myocardial infarction, bleeding, or mortality. DES was associated with fewer target lesion revascularizations (TLR): the pooled risk ratio for DCB versus DES was RR 1.82; 95% CI 1.14 to 2.91. Because the evidence was observational, the findings do not establish causality.
Key findings
- Across eight observational studies, 1,968 patients received DCB (698) or DES (1,270) after atherectomy.
- There was no statistically significant difference in MACE between strategies (RR 1.12; 95% CI 0.85 to 1.47; I 2 = 0%).
- DES was associated with lower TLR than DCB (DCB versus DES: RR 1.82; 95% CI 1.14 to 2.91; I 2 = 37.4%).
- No statistically significant differences were found for MI, major bleeding, all-cause mortality, or cardiac death.
Why it matters
A stent-free DCB strategy is a potential alternative after atherectomy, but this synthesis suggests that the choice may affect the likelihood of repeat treatment at the target lesion. The absence of significant differences in other reported outcomes is reassuring but does not establish equivalence. These results help frame the trade-offs while underscoring the need to interpret comparisons from nonrandomised evidence cautiously.
What to keep in mind
All included studies were observational, leaving the pooled comparisons vulnerable to selection bias and confounding; the findings cannot establish causal effects.