Culprit-Lesion Drug-Coated-Balloon Percutaneous Coronary Intervention in Patients Presenting with ST-Elevation Myocardial Infarction (STEMI).

: Drug-eluting stents (DESs) remain the standard of treatment for patients with ST-elevation myocardial infarction (STEMI). However, complications such as stent thrombosis and in-stent restenosis still pose significant risks. Drug-coated balloons (DCBs) have emerged as a promising alternative, but data for this clinical scenario are still scarce. The objective was to evaluate the safety and efficacy of DCB culprit-lesion primary percutaneous coronary intervention (pPCI) in patients presenting with STEMI and to evaluate its impact on the microcirculatory territory. : An observational retrospective study was conducted across six European centers. : In total, 118 patients were included. Of these, 82.2% were male, with a median age of 67 years (IQR 36-92); 28% patients presented with stent thrombosis and most of them (94%) underwent paclitaxel-DCB-pPCI. The median follow-up was 23.2 months (IQR 6.7-77.3). Target lesion failure (TLF) rates were low (3.4%), with no differences between patients presenting with native coronary vessel and stent thrombosis (4.7% vs. 0%; = 0.205). Overall mortality rates at follow-up were 7%, with only 1.8% attributed to cardiac causes. A target lesion revascularization (TLR) rate of 1.8% was observed, with no target vessel myocardial infarction reported. A subgroup of patients (42; 35.6%) underwent an adenosine-free angiographic microvascular resistance (AMR) analysis. The median AMR was 4.7 (3.9-5.5) and was greater in the stent thrombosis group than in the native coronary group (5.1 vs. 4.6; = 0.038) with no clinical differences between patients based on the AMR. : DCB-pPCI has emerged as an alternative potential treatment for patients presenting with STEMI, with few long-term adverse cardiac events. Despite the encouraging outcomes, these findings underscore the need for a large randomized clinical trial powered by a relevant clinical outcome in order to elucidate the role of DCB-PCI in patients presenting with STEMI.