Drug‐eluting stent and drug‐coated balloon for the treatment of de novo diffuse coronary artery disease lesions: A retrospective case series study

• Published in: Clinical cardiology (Mahwah, N.J.) Vol. 46; no. 12; pp. 1511 - 1518
• Main Authors: Xu, Haobo, Qiao, Shubin, Cui, Jingang, Yuan, Jiansong, Yang, Weixian, Liu, Rong, Wang, Tianjie, Guan, Hao, Tian, Tao, Zhu, Fasheng, Wang, Juan, Chang, Yue, Yang, Zhuoxuan, Liu, Shengwen
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.12.2023; John Wiley and Sons Inc
• Subjects: Acute coronary syndromes; Angioplasty; Cardiovascular disease; Clinical Investigations; Coronary vessels; de novo diffuse coronary artery disease; drug‐coated balloon; drug‐eluting stent; Flow velocity; Heart attacks; hybrid strategy; Medical imaging; Patients; quantitative flow ratio; Stents; Thrombosis; Vein & artery diseases; de novo diffuse coronary artery disease; hybrid strategy; quantitative flow ratio; drug-eluting stent; drug-coated balloon
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.24140

Background The hybrid strategy of a combination of drug‐eluting stent (DES) and drug‐coated balloon (DCB) is promising for the treatment of de novo diffuse coronary artery disease (CAD). Hypothesis To investigate the efficacy and functional results of hybrid strategy. Methods This case series study included patients treated with a hybrid approach for de novo diffuse CAD between February 2017 and November 2021. Postprocedural quantitative flow ratio (QFR) was used to evaluate the functional results. The primary endpoint was procedural success rate. The secondary endpoints were major adverse cardiovascular events (MACE) including cardiac death, myocardial infarction (MI) (including peri‐procedural MI), and target vessel revascularization. Results A total of 109 patients with 114 lesions were treated. DES and DCB were commonly used in larger proximal segments and smaller distal segments, respectively. The mean QFR value was 0.9 ± 0.1 and 105 patients (96.3%) had values >0.8 in all the treated vessels. Procedural success was achieved in 106 (97.2%) patients. No cases of cardiac death were reported at a median follow‐up of 19 months. Spontaneous MI occurred in three (2.8%) patients and target vessel revascularization in six (5.5%) patients. Estimated 2‐year rate of MACE excluding peri‐procedural MI was higher in the group with lower QFR value (12.1 ± 5.7% vs. 5.6 ± 4.4%, log‐rank p = .035) (cut‐off value 0.9). Conclusion Hybrid strategy is a promising approach for the treatment of de novo diffuse CAD. Postprocedural QFR has some implications for prognosis and may be helpful in guiding this approach. A hybrid strategy using DES and DCB showed encouraging performance and acceptable clinical outcomes for the treatment of de novo diffuse CAD. This approach also yielded promising functional results as evaluated by QFR. Higher post‐PCI QFR value was associated with better prognosis and might be helpful in guidance of this approach.