Drug‐Coated Balloon Versus Drug‐Eluting Stent for Large Coronary Arteries in Patients Presenting With STEMI: A Systematic Review and Meta‐Analysis

Drug-coated balloons (DCB) have emerged as a promising stentless strategy in percutaneous coronary intervention, but their role in ST-elevation myocardial infarction (STEMI) involving large de novo coronary arteries remains uncertain. This systematic review and meta-analysis evaluated the clinical and angiographic outcomes of DCB compared with drug-eluting stents (DES) in STEMI patients with large bservational cohorts. The primary outcomes were target lesion revascularization (TLR), major adverse cardiac events (MACE), myocardial infde novo coronary lesions (≥ 2.5 mm). A comprehensive search of PubMed, Scopus, and Web of Science was performed up to July 1, 2025, including randomized controlled trials, non-randomized trials, and oarction (MI), and cardiac and all-cause death; angiographic endpoints included minimal lumen diameter (MLD) post-PCI and at follow-up, and late lumen loss (LLL). Four studies comprising 1428 patients were included. There were no significant differences between DCB and DES in TLR (RR = 1.16, 95% CI: 0.62-2.17, p = 0.65), MACE (RR = 1.59, 95% CI: 0.64-3.97, p = 0.32), cardiac death (RR = 1.07, 95% CI: 0.55-2.09, p = 0.84), or MI (RR = 1.20, 95% CI: 0.77-1.87, p = 0.42). Post-PCI MLD was significantly higher with DES (MD = -0.29 mm, 95% CI: -0.39 to -0.20, p < 0.00001), whereas follow-up MLD did not differ significantly between groups (MD = -0.26 mm, 95% CI: -0.62 to 0.11, p = 0.17). LLL was comparable (MD = 0.02 mm, 95% CI: -0.08 to 0.11, p = 0.73). These findings suggest that DCB represents a safe and effective alternative to DES in STEMI patients with large de novo coronary artery lesions.