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Corballis, Natasha, Merinopoulos, Ioannis, Bhalraam, U., Gunawardena, Tharusha, Tsampasian, Vasiliki, Natarajan, Rajkumar 
ORCID: https://orcid.org/0000-0001-8636-8452, Wickramarachchi, Upul, Mohamed, Mohamed, Clark, Allan ORCID: https://orcid.org/0000-0003-2965-8941, Mamas, Mamas A., Vassiliou, Vassilios S. ORCID: https://orcid.org/0000-0002-4005-7752 and Eccleshall, Simon
and
SPARTAN-Norfolk Consortium
(2026)
A comparison of a drug coated balloon with drug eluting stent strategy for treating coronary bifurcation lesions.
Catheterization and Cardiovascular Interventions, 107 (1).
pp. 3-14.
ISSN 1522-1946
Abstract
Background: The treatment of coronary bifurcation lesions (CBL) remains complex and associated with a higher rate of long-term adverse cardiovascular events due to anatomical and procedural complexity. Aims: We compared procedural outcomes between a drug coated balloon (DCB) only approach and a 2nd generation drug eluting stent (DES) for treating de novo CBLs. Methods: We retrospectively identified all patients with CBL treated with either a DCB only or DES only strategy, including all coronary bifurcations and compared a bifurcation-oriented composite endpoint (BOCE) of cardiovascular death, target bifurcation-related myocardial infarction (TB-MI), and clinically driven target bifurcation revascularization (TBR) using nationally obtained clinical outcome measures from 2015 to 2019. A propensity score matched analysis was undertaken. Results: Of 2113 patients, 1030 patients were treated with a DCB and 1083 with a DES. There was higher lesion complexity in the DCB group, and propensity score-matched analysis was utilized. This included a total of 2052 patients (1026 in each arm). The median age was 68 (59−75), and all clinical presentations were included. The median follow-up time was 3.6 (2.5−4.8) years with 501 (48.8%) patients having follow-up available at 5 years. Propensity matched analysis showed a significant increase in events (14.0% vs. 9.9% respectively) (HR: 1.39 [1.08−1.79], p = 0.01) when using DES compared to DCB, driven predominantly by an increase in TBR (8.9% vs. 5.0%) (HR: 1.79 [1.27−2.50], p ≤ 0.001) and TB-MI (3.0% vs. 1.6%) (HR: 1.92 [1.05−3.57], p 0.03). Conclusions: The use of DCB-only in a coronary bifurcation is a safe alternative in treating CBL, within the limitations of a retrospective single center analysis. An appropriately designed RCT is now required.
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