Predictors of target lesion revascularization after paclitaxel-coated balloon angioplasty for de novo coronary artery lesions

Background Evidence is limited on factors driving target lesion revascularization (TLR) after drug-coated balloon (DCB) treatment for de novo coronary lesions. This study evaluated the incidence and determinants of TLR following paclitaxel-coated balloon angioplasty in an Indonesian population. Methods Single-center retrospective analysis of a prospective cohort PCI registry study included 112 patients (129 lesions) who underwent successful DCB angioplasty in de novo coronary lesions between January 2020 and December 2024 and follow-up angiography. The primary endpoint was incidence and predictors of TLR. Secondary endpoints included all-cause mortality and major adverse cardiovascular events (MACE) at 12 months. Results Over a median angiographic evaluation of 139 days (IQR, 100—291 days), TLR events occurred in 16 lesions (12.4%) and were associated with calcified lesions (adjusted OR 9.93; 95% CI, 1.23–80.46; p = 0.032. Baseline clinical characteristics, reference vessel diameter, intravascular imaging utilization, predilation procedure, balloon inflation time, maximal inflation pressure, and the presence of non–flow-limiting dissection were not associated with TLR. At 12 months, MACE (a composite of cardiac death, recurrent myocardial infarction, target lesion revascularization, unplanned rehospitalization, or cerebrovascular accident) occurred in 14 patients (12.5%) with no all-cause or cardiac mortality observed. Conclusion Calcified coronary lesions independently predicted TLR after paclitaxel-coated balloon angioplasty for de novo coronary artery lesions.