Drug‐coated balloon for the treatment of small vessel disease: 9 months of angiographic results and 12 months of clinical outcomes of the PEPCAD China SVD study

Abstract Background Whether the drug‐coated balloons (DCBs)‐alone strategy was superior to plain old balloon angioplasty (POBA) in treating SVD remains unknown. Aims We aimed to evaluate the efficacy and safety of DCBs for the treatment of coronary d e novo small vessel disease (SVD) and provide further evidence for extending the clinical indications of DCBs. (ChiCTR1800014966). Methods Eligible patients were randomized at a 2:1 ratio to receive DCB treatment or POBA in this prospective, multicenter clinical trial. The reference vessel diameter of lesions was visually assessed to be 2.0 to 2.75 mm. The primary endpoint of the study was angiographic in‐segment late luminal loss (LLL) at the 9‐month follow‐up to demonstrate the superiority of DCB treatment to POBA in SVD. The composite clinical endpoints included clinically driven target lesion revascularization (CD‐TLR), target lesion failure (TLF), major adverse cardiac events (MACEs), and thrombosis at the 12‐month follow‐up. Results A total of 270 patients were enrolled (181 for DCB, 89 for POBA) at 18 centers in China. The primary endpoint of 9‐month in‐segment LLL in the intention‐to‐treat population was 0.10 ± 0.33 mm with DCB and 0.25 ± 0.38 mm with POBA ( p = 0.0027). This difference indicated significant superiority of DCB treatment (95% CI: −0.22, −0.04, p superiority = 0.0068). The rates of the clinical endpoints—CD‐TLR, TLF, and MACEs—were comparable between groups. No thrombosis events were reported. Conclusions DCB treatment of de novo SVD was superior to POBA with lower 9‐month in‐segment LLL. The rates of clinical events were comparable between the two devices.