Preliminary experience with drug-coated balloon angioplasty in primary percutaneous coronary intervention

Abstract

We evaluated the clinical feasibility of using drug-coated balloon (DCB) angioplasty in patients undergoing primary percutaneous coronary intervention (PPCI). Between January 2010 to September 2014, 89 ST-elevation myocardial infarction patients (83% male, mean age 59 ± 14 years) with a total of 89 coronary lesions were treated with DCB during PPCI. Clinical outcomes are reported at 30 d follow-up. Left anterior descending artery was the most common target vessel for PCI (37%). Twenty-eight percent of the patients had underlying diabetes mellitus. Mean left ventricular ejection fraction was 44% ± 11%. DCB-only PCI was the predominant approach (96%) with the remaining 4% of patients receiving bail-out stenting. Thrombolysis in Myocardial Infarction (TIMI) 3 flow was successfully restored in 98% of patients. An average of 1.2 ± 0.5 DCB were used per patient, with mean DCB diameter of 2.6 ± 0.5 mm and average length of 23.2 ± 10.2 mm. At 30-d follow-up, there were 4 deaths (4.5%). No patients experienced abrupt closure of the infarct-related artery and there was no reported target-lesion failure. Our preliminary experience showed that DCB angioplasty in PPCI was feasible and associated with a high rate of TIMI 3 flow and low 30-d ischaemic event.

Keywords: Acute myocardial infarction; Drug coated balloon; Efficacy; Primary angioplasty; Safety.

Figure 1

Thrombus aspiration (for visible thrombus) and predilatation with a non-coated balloon prior to drug-coated balloon angioplasty as the final step. A: Baseline coronary angiography showing acute thrombotic occlusion of mid right coronary artery (RCA); B: Mid RCA after thrombus aspiration; C: Predilatation of mid RCA with non-coated balloon; D: Final angiography of mid RCA (after DCB angioplasty).