Clinical Outcomes of Using Drug Coated Balloons During Primary Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction Patients – Insights from High-Risk Groups: A Single Centre Experience

Objective: ST elevation myocardial infarction (STEMI) is one of the leading causes of mortality worldwide. Currently, the guidelines recommend primary percutaneous coronary intervention (PPCI) using drug eluting stents as the standard management for those patients. Stent-free PCI using drug coated balloons (DCB) has been suggested as novel approach to avoid stent-related complications. This study aimed to assess the efficacy and safety of using DCB in STEMI patients.
Methods: We compared STEMI patient presented during the period between 2019-2023 and underwent primary PCI using DCB to those treated with DES in terms of in-hospital and 6 months Major Adverse Cardiac Events (MACE).
Results: A Total 128 STEMI patient underwent primary PCI using DCB were compared to 128 matched patients managed using DES. Small vessels culprit less than 3 mm and distal lesions were significantly higher in DCB compared to DES. DCB were used in major epicardial vessels in around 55% of patients and in side branches in almost 45% of cases. Regarding MACE either in-hospital or within 6 months, there was no significant difference between the two groups. Moreover, on 6 months follow up, MACE, reinfarction, and repeat revascularization were numerically lower but statistically non-significant in DCB group. Subgroup analysis showed that in-hospital MACE and reinfarction rates were statistically significant higher if DCB was applied to large vessels >3 mm and in-stent thrombosis (P value= 0.014 and 0.001 respectively).
Conclusion: DCB appears non-inferior to DES during primary PCI in terms of MACE including mortality and reinfarction even in major epicardial coronaries. However, it should be used cautiously in certain lesions subsets especially large vessels >3mm and in-stent thrombosis.

Keywords: Drug coated balloons, drug eluting stents, primary percutaneous coronary intervention, ST elevation myocardial infarction