There might come the time when we are finally able to leave nothing behind, at least in the context of primary PCI. The REVELATION study, soon to be published in J Am Coll Cardiol Intv, has shown that paclitaxel coated balloons resulted non inferior to drug eluting stents (DES) in terms of FFR (fractional flow reserve) 9 months after PCI. Not only did they result inferior, but also safe and feasible.
In the context of acute myocardial infarction and primary PCI, drug eluting stents have been shown effective in terms of repeat revascularization, but the difference in recurrent infarctions or death is not that clear when compared to drug coated balloons. Drug coated balloons might bridge the gap in repeat revascularization, with the benefit of leaving no prosthesis behind.
The REVELATION randomized 120 STEMI patients to paclitaxel coated balloon vs. DES in culprit lesions with no severe calcification. Primary end point was FFR measurement.
Read also: STEMI in Coronary Dissections. When Should We Do It and What Are Its Outcomes?
At 9 months, mean FFR was 0.92 ± 0.05 for drug coated balloons vs. 0.91 ± 0.06 for DES (p=0.27). One patient presented acute closure of target vessel after DCB and one patient in each group required non urgent target vessel revascularization.
Conclusion
In the context of ST elevation AMI, primary PCI with paclitaxel coated balloon resulted non inferior to DES stenting. PCI with drug coated balloon appears safe and feasible in this scenario.
Título original: Paclitaxel-Coated Balloon Angioplasty Versus Drug-Eluting Stent in Acute Myocardial Infarction. The REVELATION Randomized Trial.
Referencia: Nicola S. Vos et al. J Am Coll Cardiol Intv 2019, article in press.
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