Heart Lung Circ. 2026 Jul 31:S1443-9506(26)00206-4. doi: 10.1016/j.hlc.2026.03.059. Online ahead of print.
ABSTRACT
BACKGROUND & AIMS: Recent trends towards a "leave nothing behind" strategy are reshaping coronary artery disease management. Drug-coated balloons (DCB) deliver an antiproliferative drug via their abluminal surface, reducing neointimal proliferation without risks attributable to drug-eluting stents (DES). While emerging data support DCB safety and efficacy, real-world usage and outcome data remain limited. This study examines DCB use, trends, and clinical outcomes in Victoria, Australia.
METHOD: Registry data from all percutaneous coronary intervention-capable centres within the Victorian Cardiac Outcomes Registry over an 11-year period from January 2013 to December 2023 were collected. Indications for DCB use, short and long-term mortality, and 30-day major adverse cardiovascular events, defined as cardiac death, myocardial infarction, target vessel revascularisation or target lesion thrombosis, were assessed.
RESULTS: Among 117,308 patients undergoing percutaneous coronary intervention during the study period, 1,266 received DCB-only intervention, rising from 0.17% in 2013 to 2.8% in 2023. Compared with DES, DCB recipients were older (69.0 vs 66.5 years; p=0.002), with higher lesion complexity (B2/C; 70.1% vs A/B1; 29.9%). The predominant indication for DCB was stable angina (70.2%), followed by myocardial infarction (ST-elevated myocardial infarction [STEMI] 5.3%, non-STEMI 17.1%) and unstable angina pectoris (unstable angina pectoris 7.4%). Thirty-day all-cause mortality and major adverse cardiovascular events rates in the DCB group compared to DES remained low (0.5% vs 1.6%; p=0.012, and 1.6% vs 3.0; p=0.009). A total of 470 patients (0.4%) received a combination DCB and DES strategy over the study period.
CONCLUSIONS: DCB usage has significantly increased over the past decade, reflecting evolving clinical practice, although absolute numbers remain small. With advancing guidelines, growing experience, and emerging evidence, its utilisation is expected to rise further.
PMID:42538224 | DOI:10.1016/j.hlc.2026.03.059