Insights into DCB-Only Strategy for Left Main Coronary Artery Disease

Sanna Uskela and colleagues, from the Heart Center at North Karelia Central Hospital in Finland, conducted a retrospective single-center registry study focusing on the utilization of a drug-coated balloon (DCB)-only approach for the treatment of de novo left main coronary artery disease. This investigation is noteworthy as it explores a therapeutic strategy that has not been extensively examined previously, particularly in the context of patients at high risk of bleeding.

The study enrolled all consecutive patients who underwent percutaneous coronary intervention (PCI) for a de novo left main coronary artery lesion using the DCB-only approach between August 2011 and December 2018. The primary endpoint was major adverse cardiovascular events (MACEs), comprising cardiac death, non-fatal myocardial infarction, and target lesion revascularization (TLR). The cohort was stratified into two groups based on adherence to international consensus group guidelines for lesion preparation.

Discover more about interventional cardiology at in-person conferences and online courses. Learn and advance your expertise!

Key observations from the study include:

1. The study enrolled 66 patients with an average age of 75±8.6 years, with males representing 72% of the cohort. Acute coronary syndrome was present in 52% of patients.
2. There were no procedural deaths or acute closures of the treated left main coronary artery.
3. At the 12-month mark, MACEs and TLR occurred in 24% and 6% of the entire cohort, respectively. When lesion preparation followed guidelines, MACE and TLR rates significantly decreased to 21.2% and 1.9%.
4. The study concluded that PCI of the left main coronary artery using the DCB-only approach is safe and results in acceptable rates of MACE and low TLR at one year with guideline-compliant lesion preparation.

The study underscores the critical role of proper lesion preparation in the DCB-only approach for de novo left main coronary artery disease. Furthermore, it highlights the potential advantages of this strategy, particularly in high-risk bleeding patients, where the DCB-only approach may allow for shorter or even no dual antiplatelet therapy (DAPT), thereby reducing the risk of bleeding complications.

Limitations of the study include its retrospective design, the relatively small sample size, and the overrepresentation of high-risk bleeding, elderly, and patients with complex calcified left main lesions. Nonetheless, the study provides valuable insights into the DCB-only approach for left main coronary artery disease and suggests that with appropriate lesion preparation, this strategy could be a feasible option for high-risk bleeding patients.

This article represents a significant contribution to interventional cardiology, especially for clinicians and researchers interested in PCI strategies for left main coronary artery disease and the management of high-risk bleeding patients. It calls for future randomized trials comparing DCB angioplasty to dxrug-eluting stent (DES) implantation to validate these findings and further explore the potential advantages and limitations of the DCB-only approach.

For more information: Drug-coated balloon-only strategy for percutaneous coronary intervention of de novo left main coronary artery disease: the importance of proper lesion preparation, Frontiers Journals, https://doi.org/10.1007/s11684-022-0950-1