Drug coated balloon treatment with or without long inflation time in patients undergoing percutaneous coronary intervention: a propensity score matching analysis

Abstract Aim Although drug coated balloon (DCB) treatment for coronary de novo or in-stent restenosis lesions is a widespread strategy, consensus is lacking regarding appropriate DCB inflation time during percutaneous coronary intervention (PCI). We sought to evaluate the effect of long inflation time of DCB on procedural results and clinical outcomes after PCI. Methods Between January 2019 and August 2020, 314 consecutive patients with 445 lesions underwent intravascular imaging-guided PCI with paclitaxel DCB using different inflation time. In the entire cohort, the median follow-up duration was 966 days. We classified patients into DCB inflation time of ≥180 sec (prolonged group, n = 101) or <180 sec (standard group, n = 212). The primary clinical endpoint was a composite of death, myocardial infarction (MI), stroke, and target lesion revascularization. One-to-one propensity score matching was performed for potential bias. A total of 92 pairs were matched. Results In the matched population, the median age was 73 years, 82.1% was male, and 35.8% was treated for in-stent restenosis. The median duration of DCB inflation was 300 sec in the prolonged group and 60 sec in the standard group during PCI. After PCI, angiographic acute lumen gain was similar between the groups, but diameter stenosis was smaller in the prolonged group than in the standard group (30.0% vs. 33.5%, p = 0.042). Intravascular ultrasound (IVUS) analysis revealed that the prolonged group resulted in smaller plaque burden at the MLA (61.9% vs. 66.7%, p = 0.002), smaller area stenosis (66.6% vs. 69.4%, p = 0.044), and less mean increase in percent atheroma volume (-11.2 ± 7.1% vs. -7.4 ± 5.9%, p = 0.004). The rate of the primary clinical endpoint was lower in the prolonged group compared with the standard group (log-rank p = 0.025). The rate of IVUS dissection and hematoma and the incidence of periprocedural MI were not different among the 2 groups. Conclusions Despite comparable acute lumen gain, long DCB inflation time was associated with favorable angiographic and IVUS results and reduced adverse events compared with standard DCB treatment in patients with coronary artery disease.