Drug-Coated Balloons Versus Non-Coated Balloons for Side Branch Treatment in Bifurcation Lesions: A Systematic Review and Meta-Analysis.

BACKGROUND

Coronary bifurcation lesions (CBL) account for ~20% of percutaneous coronary interventions (PCI). When using provisional stenting, optimal management of a diseased side branch (SB) remains debated. Drug-coated balloons (DCBs) are an emerging option, but data on their role in CBL PCI are limited.

AIMS

We conducted a meta-analysis to compare DCBs and non-compliant balloons (NCBs) for SB treatment.

METHODS

A systematic search of MEDLINE, CENTRAL, and EmBase (until November 2024) identified studies comparing DCBs and NCBs for treating the SB. From 1451 studies, five were included (two randomized controlled trials [RCTs], three observational), with 1762 patients, predominantly male with acute coronary syndrome (ACS). The primary outcome was major adverse cardiac events (MACE); secondary outcomes included myocardial infarction (MI), target lesion revascularization (TLR), and target vessel revascularization (TVR).

RESULTS

DCBs significantly reduced MACE (pooled OR 0.48, 95% CI 0.34-0.68, p < 0.0001, I² = 0%) and MI (pooled OR 0.39, 95% CI 0.25-0.62, p < 0.001, I² = 0%) compared to NCBs. No significant differences were observed in TLR or TVR. Subgroup analysis confirmed consistency across observational studies and RCTs for MACE and MI.

CONCLUSIONS

DCBs in SB treatment during CBL PCI are associated with reduced MACE and MI compared to NCBs, with no significant differences in vessel-specific outcomes. These findings suggest a potential clinical benefit of DCBs in reducing ischemic events, while limiting stenting in CBL. Further research is needed to refine patient selection and optimize outcomes.