Drug-Coated Balloon versus Drug-Eluting Stent in Patients with Small-Vessel Coronary Artery Disease: A Meta-Analysis of Randomized Controlled Trials

Background Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) of small-vessel coronary artery disease (SVD) is related to an increased risk of in-stent restenosis (ISR) and stent thrombosis (ST). The application of the drug-coated balloon (DCB) for patients with SVD remains controversial. Objectives Assess the outcomes of DCB in the treatment of SVD compared with DES in patients with SVD. Methods A meta-analysis of randomized controlled trials (RCTs) published up to June 2020, reporting the outcomes of DCB versus DES in the treatment of SVD, was performed. Results Four RCTs with 1227 patients were included. The results indicated that DCB was associated with the decreased risk for myocardial infarction (MI) compared with the DES, but the difference showed no significance (OR 0.50, 95% CI 0.24-1.03, P=0.06). And, there was no significant difference in death (OR 0.76, 95% CI 0.17-3.43, P=0.72), cardiac death (OR 1.92, 95% CI 0.74-4.98, P=0.18), target vessel revascularization (TVR) (OR 0.81, 95% CI 0.51-1.28, P=0.36), target lesion revascularization (TLR) (OR 1.29, 95% CI 0.66-2.52, P=0.46), and major adverse cardiac events (MACE) (OR 0.92, 95% CI 0.61-1.38, P=0.69) between the DCB group and DES group. Conclusion Compared with DES, DCB was associated with a decreased risk of MI among patients with SVD, but the difference showed no significance. The application of DCB in SVD is associated with comparable outcomes of death, TVR, and MACE when compared with DES.