DEBS-033 | Drug-Coated Balloons in Complex Chronic Total Occlusions: Evidence for a Remodeling-Oriented Strategy in Contemporary CTO-PCI

Background/Introduction: Despite rapid advances in drug-coated balloon (DCB) technology, evidence in acute coronary syndromes (ACS) remains limited, particularly in large, unselected real-world populations.Comparative assessment of one-year reinfarction, cardiovascular death, and target vessel revascularization (TVR) provides a stringent benchmark of procedural durability and clinical safety.This study evaluated these outcomes across DCB-only, DES-only, and hybrid PCI strategies in a high-volume, all-comer STEMI/NSTEMI cohort.Methods: A total of 2709 STEMI/NSTEMI patients undergoing PCI were included.The mean age was 63.9 11.8 years, with 1919 men and 790 women.PCI strategies consisted of DES-only (n = 2433), DCB-only (n = 118), and hybrid DCB + DES PCI (n = 158).One-year outcomes were defined strictly as reinfarction, cardiovascular death, or TVR within 365 days of discharge.Sex-specific analyses were performed.Results: One-year adverse events were infrequent across all strategies.DCB-only PCI demonstrated the lowest event rate, with 3 events among 118 patients (2.5%), compared with 103/2433 (4.2%) after DESonly PCI and 9/158 (5.7%) after hybrid PCI.Event rates were 4.7% in men and 3.0% in women.Women exhibited consistently low event rates across treatment strategies, including 0% events in the hybrid group, though subgroup sizes were small.Overall, DCB-only PCI showed numerically favorable performance despite selective use. Conclusions:In this large all-comer STEMI/NSTEMI cohort, one-year reinfarction, cardiovascular death, and TVR occurred infrequently across PCI strategies.DCB-only PCI demonstrated the most favorable one-year profile, outperforming DES numerically.These findings support the clinical safety and procedural durability of DCB-based PCI in ACS and justify further expansion of DCB strategies beyond elective lesions.