Should We Use Drug Coated Balloons in Patients with Multivessel Disease?

Recent studies have shown that a drug coated balloons (DCB) based approach resulted non inferior when compared against drug eluting stents (DES) only approach in patients with instent restenosis and de novo lesions in small vessel disease. So far, two international consensuses have reported the use of DCB is feasible and safe to treat native vessels instead of DES. 

¿Debemos utilizar balones liberadores de droga en pacientes con enfermedad de múltiples vasos?

A registry of patients in South Korea has shown that a higher number of longer stents was a significant predictor of ischemic events in patients with multivessel disease. 

The aim of this retrospective study carried out in South Korea was to look at clinical outcomes of patients with multivessel disease treated with DCB or a combination of DCB and DES. 

Primary end point was major adverse cardiovascular event (MACE) incidence, defined as cardiac death, AMI, stroke, probable or definite stent thrombosis, target vessel revascularization and major bleeding at 2 years. 

It included 254 patients meeting multivessel criteria, treated with DCB or a combination of DCB and DES. These were matched with propensity score (PSM) to 254 patients of the PTRG-DES registry (Platelet Function and Genotype-Related Long-Term Prognosis in Drug-Eluting Stent-Treated Patients with Coronary Artery Disease) to be compared against the DES-only group. 

Read also: Intracoronary Brachytherapy for Drug-Eluting Stent Restenosis.

Patient mean age was 63 and they were mostly men. The most frequent clinical presentation in the DES-only group was stable angina, while in the DCB-based group, unstable angina was most prevalent. Among DCB patients, 34.3% were treated with DCB only and 65.7% with the hybrid strategy combining DES + DCB. There were no differences in baseline clinical characteristics between the groups. The number of stents and total stent length was significantly lower in the DCB group vs. the DES-only group. 

As regards the primary end point, the DCB group presented lower risk of MACE vs DES-only, at 2 years. (3.9% vs 11.0%; P = 0.002).

Cardiac death was higher in the DES group (0.4% vs 2.4%; P = 0.047), and major bleeding was also more prevalent in this group (0.4% vs; 2.8%; P = 0.027). 


The DCB-based approach showed significantly fewer stents in multivessel PCI, which lead to reduced MACE rate at 2 year followup. These findings confirm the safety of DCB, and the long term benefit we can expect, seeing as it reduces stent burden. Further retrospective controlled studies are needed to assess the role of DCB.

Dr. Andrés Rodríguez

Dr. Andrés Rodríguez.
Member of the editorial board of

Original Title: Clinical Impact of Drug-Coated Balloon–Based Percutaneous Coronary Intervention in Patients With Multivessel Coronary Artery Disease.

Reference: Eun-Seok Shin, MD et al J Am Coll Cardiol Intv 2023.

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