Abstract 4366904: Drug-coated balloons versus drug-eluting stents in patients with Large coronary artery disease: an updated meta-analysis

Background and Aim: Coronary artery disease (CAD) accounted for 2.2% of the global disease burden and 32.7% of cardiovascular disorders. Drug-coated balloon (DCB) is a known treatment option for in-stent restenosis and small vessel coronary artery disease (CAD). Although the use of DCB is increasing in everyday practice, data regarding performance in the treatment of de novo, large vessel CAD(LV-CAD) is still lacking. So, we aim to evaluate the safety and efficacy of DCB compared to DES in de-novo LV-CAD. Method: We searched four electronic databases from inception until April 2025. We included studies that compared DCB and DES in de-novo LVD. The primary endpoint was target lesion revascularization (TLR), late lumen loss (LLL) and acute lumen gain (ALG). The secondary endpoints were safety outcomes Results: Thirteen studies comprising 6,793 patients were included in this meta-analysis. The incidence rate of TLR was 3.5% in the DCB group compared to 5.8% in the DES group, without a significant difference in the risk of TLR (OR=0.65, 95% CI [0.42 to 1.01], p=0.054; I2=0%,p=0.60). Moreover, DCB significantly reduced late lumen loss (LLL) compared to DES (MD=-0.18, 95% CI [-0.30 to -0.10], p<0.001; I2=67.2%,p<0.01) while DES proved a higher mean acute gain compared to DCB (MD= -0.52, 95% CI [--0.69 to -0.34], p<0.001; I2=80.7%,p<0.01). Conclusion: DCB was non-inferior to DES in treating de-novo LVD lesions while potentially reducing TLR rates.The comparable mortality rates and reduced LLL in the DCB group challenge the traditional preference for DES in do-novo LVD.