Evidence not strong enough to support routine use of DCBs for STEMI

18 Oct 2020
Favourable long-term results with zotarolimus-eluting stents in CTO

While drug-coated balloons (DCBs) perform largely comparably to drug-eluting stents (DESs), there is still insufficient evidence to recommend its routine use in patients with ST-elevation myocardial infarction (STEMI), reports a new meta-analysis.

The quantitative analysis included three studies, corresponding to 284 STEMI patients, of whom 138 received DCBs and the remaining 146 were given DESs. Two of the eligible studies were randomized controlled trials (RCT), while the last one was a post-hoc analysis of an RCT.

Target lesion revascularizations occurred more commonly in DCB-treated patients, but not significantly so. The resulting risk estimate was likewise nonsignificant (6.5 percent vs 2.7 percent; odds ratio [OR], 2.51, 95 percent confidence interval [CI], 0.76–8.25; p=0.13).

Similarly, acute thromboses (2.9 percent vs 0 percent; OR, 5.16, 95 percent CI, 0.59–44.97; p=0.14) and major adverse cardiac events (6.5 percent vs 3.4 percent; OR, 1.98, 95 percent CI, 0.69–5.74; p=0.21) were both only nominally elevated in DCB vs DES patients.

The same was also true for myocardial infarctions (1.4 percent vs 1.3 percent; OR, 0.97, 95 percent CI, 0.13–7.29; p=0.98) and all-cause mortality (0.7 percent vs 0 percent; OR, 3.76, 95 percent CI, 0.15–94.83; p=0.42).

On the other hand, type D or worse coronary dissections occurred in a significantly greater frequency in DCB patients (14.5 percent vs 0 percent; OR, 18.4, 95 percent CI, 3.48–93.61; p=0.0006). This contributed to bailout stenting with a bare-metal stent, which also occurred more frequently in DES patients.

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