Efficacy of drug-coated balloon angioplasty for coronary chronic total occlusion: A systematic review and meta-analysis.

Percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) is associated with worse outcomes compared to non-CTO lesions. Whether the implantation of drug-eluting stents (DES) is the cornerstone treatment after successful recanalization of CTO, recent evidence tested the clinical performance of DCB-based PCI, alone or in concert with DES (hybrid DCB/DES approach), in this context. We aimed to conduct a comprehensive, up-to-date systematic review and summary-level meta-analysis of clinical studies comparing outcomes of DCB-based versus DEB-only angioplasty for coronary CTOs. A systematic search was performed to identify all investigations comparing DCB-based versus DES-only angioplasty for coronary CTOs. The primary endpoint was the occurrence of target vessel failure (TVF), a composite outcome of cardiac death, nonfatal myocardial infarction and target vessel revascularization. A total of 5 observational studies (2087 patients) were included in the analysis. The DCB-based PCI group experienced a trend towards a lower rate of TVF (0.45 % (112/25045) vs. 0.76 % (238/31336) person-months, IRR = 0.56 [95 % CI 0.28 to 1.10], I = 81 %, p = 0.09) and cardiac death (0.05 % vs. 0.10 % person-months, IRR = 0.55 [95 % CI 0.27 to 1.10], I = 0 %, p = 0.09), although a high extent of heterogeneity was observed. Other endpoints were not different between the two groups. In the present meta-analysis, DCB-based PCI was associated with similar outcomes compared to second-generation DES PCI for the treatment of coronary CTOs. Future randomized controlled trials will provide more robust evidence on the effectiveness of DCB in treating coronary CTOs.