Long-Term Efficacy of Drug-Coated Balloon Angioplasty vs. Drug-Eluting Stent for De Novo Large-Vessel Coronary Arteries

Background: Drug-coated balloon (DCB) angioplasty has shown short-term feasibility for large-vessel coronary artery disease (CAD; ≥3 mm); however, long-term outcomes remain unclear. This study aimed to evaluate the 5-year cardiovascular outcomes of DCB angioplasty vs. drug-eluting stents (DES) for de novo large-vessel CAD. Methods and Results: This single-center retrospective study analyzed patients undergoing percutaneous coronary intervention (PCI) with either DCB (SeQuent Please) or DES (Xience Alpine) between January 2016 and December 2018. The primary outcomes were cardiovascular events (CVE), defined as a composite of cardiac death, non-fatal myocardial infarction, and target lesion revascularization (TLR). Secondary outcomes included minimal lumen diameter (MLD), diameter stenosis (DS), and late lumen loss (LLL), assessed at the index PCI and at the 1-year angiographic follow up. Overall, 114 patients (122 lesions) in the DCB group and 269 patients (293 lesions) in the DES group were analyzed, with similar median follow-up durations (1,678 vs. 1,825 days; P=0.687). At 5 years, TLR and CVE rates were comparable between the DCB and DES groups (7.9% vs. 4.5%, P=0.239; and 11.4% vs. 10.4%, P=0.773, respectively). No significant differences in MLD, DS, or LLL were observed between the groups at the 1-year follow up. Conclusions: With careful lesion selection and preparation, DCB angioplasty could serve as a feasible treatment option for de novo large-vessel CAD in clinical practice.