A retrospective analysis of long-term outcomes of DCB compared to DES in aorto-ostial lesions

Aim: Aorto-ostial coronary lesions (AOL) represent a technically challenging subset of coronary artery disease with historically high restenosis rates, even with contemporary drug-eluting stent (DES) platforms. Drug-coated balloons (DCB) offer a stent-less alternative strategy; however, data on their use in AOL are limited. We aimed to compare long-term clinical outcomes of DCB versus DES in de novo AOL.

Methods and Results: We identified all patients undergoing percutaneous coronary intervention (PCI) with either DCB or DES for de novo AOL as their first procedure between January 2015 and November 2019. Patients presenting with cardiac arrest, intubation, or cardiogenic shock were excluded. The primary endpoint was target lesion failure (TLF), defined as a composite of target lesion revascularisation (TLR), target lesion myocardial infarction (TLMI), and cardiovascular death. Secondary endpoints included the individual components of TLF and all-cause mortality. Clinical outcomes were obtained using national outcome datasets. Overall, 211 patients with AOL were included; 62 (29.4%) underwent PCI using a DCB-only strategy and 149 (70.6%) were treated with DES only. The mean age was 70.7 ± 11.6 years, and 68.7% were male. The mean treated vessel diameter was smaller in the DCB compared with the DES group (3.64 ± 0.42 mm vs 3.92 ± 0.61 mm; p=0.002). At a median follow-up of 3.8 years, TLF occurred in 9 patients (14.5%) in the DCB group and 22 patients (14.8%) in the DES group (unadjusted HR 0.996, 95% CI 0.459–2.165; p=0.993). After adjustment for treatment strategy, diabetes, and calcification, DCB use was not associated with an increased risk of TLF compared with DES (adjusted HR 0.948, 95% CI 0.434–2.072; p=0.893). No significant differences were observed in secondary endpoints. Kaplan–Meier analyses demonstrated comparable event-free survival between groups up to 5 years.

Conclusion: In this real-world cohort, a DCB-only strategy for aorto-ostial coronary lesions was feasible and safe, with long-term clinical outcomes comparable to DES. These findings support DCB as a potential alternative strategy in selected AOL patients.