Analysis Of Safety And Efficacy Of Drug-Coated Balloon In The Treatment Of Ostial Left Anterior Descending Artery Lesions

BackgroundWith the development of percutaneous coronary intervention(PCI),drug-eluting stenting has become the standard method of PCI.However,there are still many problems existing,such as short-term stent dislodgment,acute stent thrombosis and long-term stent restenosis.When drug-coated balloon(DCB),a combination of balloon angioplasty and local drug delivery,is dilated,the anti-proliferative drugs diffuse into the vessel wall without leaving permanent implants.Compared with drug-eluting stent(DES),DCB can achieve an uniform drug distribution over the lesion segment.Meanwhile the drug remains in the tissue for only about two weeks,which can promote early re-endothelialization of the intima,accelerating vascular repair,reducing the risk of acute or late thrombosis,and shortening the duration of dual antiplatelet therapy(DAPT).DCB has showed advantages in small vessel disease,in-stent restenosis,stenosis in diabetes and high risk of bleeding.Ostial left anterior descending artery(LAD)lesions usually affect a large area of myocardium,and often influence the distal left main(LM)or the ostial left circumflex(LCX),so PCI of ostial LAD lesions is quite a tough issue,which needs high technical requirements.However,current researches on DCB mainly focus on small vessels and in-stent restenosis.There are few studies on DCB,compared with DES,in the treatment of ostial LAD.ObjectiveThe purpose of this study was to investigate the safety and efficacy of drug-coated balloon in the treatment of ostial anterior descending artery lesions compared with drug-eluting stent.MethodsFrom October 2014 to December 2019,a total of 182 patients with severe stenosis at the ostial anterior descending artery(LAD)were retrospectively enrolled from the Department of Cardiology,the First Affiliated Hospital of Zhengzhou University.According to the final results,they were divided into drug-balloon group(DCB group,n=65),drug-eluting stent group(DES group,n=97)and drug-balloon+bail-out group(combination group,n=20).Baseline data at admission was recorded including age,gender,type of angina pectoris,comorbidities and previous history(hypertension,diabetes,hyperlipidemia family history,smoking history,renal insufficiency,cardiac insufficiency,peripheral vascular disease,rheumatic immune disease,myocardial infarction history,PCI history,CABG history,etc.),imaging examination,laboratory texts(C-reactive protein,estimated glomerular filtration rate,glycosylated hemoglobin,N-terminal pro brain natriuretic peptide).Quantitative coronary angiography analysis was done for follow-up patients.The primary efficacy index was restenosis and revascularization of the target lesion,the secondary index was late lumen loss,and the safety index included cardiac death non-fatal myocardial infarction,heart failure,etc.Results1.The age of patients in DCB group,DES group and combination group were 56.7± 10.1 years old,61.9± 9.8 years old and 57.5±9.4 years old respectively.The age difference was statistically significant(P=0.001)between DCB group and DES group.There were no significant differences(P>0.05)in other data such as gender,angina type,complications,laboratory indexes,LVEF,etc.among the three groups.2.The calcification of target lesions in DES group was significantly more than that in DCB group(P<0.001).11(11.3%)patients in DES group underwent Rotational Atherectomy.3.Angiographic outcomes and QCA analysis:the median angiographic follow-up period of DCB,DES and combination group were 6.5 months,12 months and 11.5 months respectively.Compared with DES group,DCB group had less postprocedural minimum lumen diameter(MLD),MLD at follow-up,postprocedural diameter stenosis,diameter stenosis at follow-up and acute lumen gain(P<0.05).There was no significant difference(P>0.05)in reference diameter and late lumen loss among the three groups.In DCB group,14(29.8%)patients had late lumen enlargement(minimal lumen diameter from 2.43± 0.43mm to 2.56 ± 0.47mm,P<0.001),where the difference was statistically significant(P<0.05)compared with the other two groups.4.Clinical outcomes:the median clinical follow-up period of the DCB,DES and combination group was 35 months,40.3 months and 31 months respectively.Eight patients(5 in DCB group,2 in DES group and 1 in combination group)underwent revascularization due to restenosis of target lesions,and there was no statistically significant difference among the three groups(P>0.05).During the follow-up,3 patients died(1 in DCB group and 2 in DES group),and only 1 patient in DCB group died of cardiac events.There were 1 case of myocardial infarction and 2 cases of heart failure in DES group.The rate of MACE in DCB group,DES group and combination group was 9.5%,6.0%and 5.3%respectively,and there was no statistically significant difference among the three groups(P>0.05).ConclusionCompared with drug-eluting stent,drug-coated balloon is similarly safe and effective in the treatment of ostial anterior descending artery lesions.The combination of DCB and bail-out DES is also safe and effective.