Drug-Coated Balloon-Based Intervention for De Novo Acute Myocardial Infarction

Purpose: Data on drug-coated balloon (DCB) treatment in acute myocardial infarction (AMI) are limited. We aimed to assess the efficacy and safety of DCB revascularization in percutaneous coronary intervention (PCI) in patients with de novo AMI. Materials and Methods: Three hundred twenty-nine patients with de novo AMI who were successfully treated with DCB-based PCI were retrospectively enrolled. Patients treated with DCB-based PCI were compared to propensity score-matched patients who underwent conventional PCI with second-generation drug-eluting stent (DES), using data from a DES registry. Both groups were followed over 2 years to assess net adverse cardiovascular events (NACE). Results: The cumulative incidences of NACE [6.2% vs. 10.8%; hazard ratio (HR) (95% confidence interval, CI): 0.54 (0.33–0.88); p=0.014], target vessel revascularization [1.7% vs. 5.7%; HR (95% CI): 0.33 (0.13–0.80); p=0.014], and major bleeding [0.8% vs. 3.2%; HR (95% CI): 0.21 (0.05–0.83); p=0.027] were significantly lower in the DCB-based group compared to the DES-only group after 2 years of follow-up. These results remained consistent after adjusting for baseline differences using multivariable regression, propensity score matching, and inverse probability of treatment weighting. In a multivariable model, DCB-based PCI was independently associated with reduced risk of 2-year NACE, target vessel revascularization, and major bleeding. Conclusion: In patients with de novo AMI, DCB-based PCI showed more favorable clinical outcomes after 2 years of follow-up compared to conventional DES-only PCI. DCB-based PCI may serve as a safe and effective alternative to DES-only PCI in carefully selected patients with satisfactory pre-dilation results (Impact of Drug-Coated Balloon Treatment in De Novo Coronary Lesion; NCT04619277).