Background:Drug-coated balloons(DCBs)are receiving increasing attention in interventional therapy for coronary artery disease.However,evidence regarding their application in acute myocardial infarction(AMI),particular...Background:Drug-coated balloons(DCBs)are receiving increasing attention in interventional therapy for coronary artery disease.However,evidence regarding their application in acute myocardial infarction(AMI),particularly in high-risk AMI patients,is limited,leading to significant clinical concerns.This study aims to compare the efficacy and safety of DCBs versus standard drug-eluting stents(DESs)in AMI patients and explore their efficacy differences in patients with ST-segment elevation myocardial infarction(STEMI),non-ST-segment elevation myocardial infarction(NSTEMI),and different risk stratifications.Methods:A single-center,retrospective cohort study was conducted,involving 86 patients who underwent percutaneous coronary intervention(PCI)for AMI between January 2023 and July 2025.Patients were divided into a DCB group(n=26)and a DES group(n=60)based on the treatment modality.According to the Killip classification of myocardial infarction at admission,patients were categorized into a low-risk group(Killip Class I,n=68)and a high-risk group(Killip Classes II-IV,n=18).The primary efficacy endpoint was targeting lesion restenosis as shown by coronary angiography follow-up(6-12 months).Safety endpoints included acute in-stent thrombosis during hospitalization(ARC criteria)and long-term coronary slow flow.A multivariate logistic regression model was used to evaluate the associations between intervention modality,risk stratification,infarction type,and endpoint events,and to test for interactions.Results:The DCB and DES groups were generally balanced in terms of baseline traditional risk factors.During hospitalization,three cases(5.0%)of acute in-stent thrombosis occurred in the DES group,all requiring urgent re-intervention,while no such events occurred in the DCB group(0%).Acute in-stent thrombosis formation was significantly associated with high-risk stratification(χ2 test,p=0.047).The overall restenosis rate was 22.1%(19/86).Multivariate analysis showed no statistically significant difference in restenosis risk between the intervention modalities(DCB vs.DES)(adjusted odds ratio[OR]=1.07,95%confidence interval[CI]0.27-4.21,p=0.920),and no statistical differences were found in subgroups based on risk stratification(p=0.382)or infarction type(p=0.484).There was a trend toward increased restenosis risk in high-risk patients(OR=12.34),but the difference was not statistically significant(95%CI 0.28-542.75,p=0.193).The incidence of long-term coronary slow flow was significantly higher in the DES group than in the DCB group(16.7%vs.3.8%,Fisher’s exact test,p=0.048),with a statistically significant difference.Conclusion:For AMI patients,DCBs demonstrate similar efficacy to DESs in preventing restenosis.However,DESs are associated with a higher risk of acute thrombosis during hospitalization,especially in high-risk patients,and a higher risk of long-term slow coronary flow.DCBs exhibit superior perioperative and long-term safety compared to DESs.Given the limited sample size,particularly the small number of high-risk patients and those treated with DCBs,the conclusions require validation through larger-scale prospective studies.展开更多
基金Social Development Science and Technology Project of Dongguan Science and Technology Bureau(Project No.:20221800905302)。
文摘Background:Drug-coated balloons(DCBs)are receiving increasing attention in interventional therapy for coronary artery disease.However,evidence regarding their application in acute myocardial infarction(AMI),particularly in high-risk AMI patients,is limited,leading to significant clinical concerns.This study aims to compare the efficacy and safety of DCBs versus standard drug-eluting stents(DESs)in AMI patients and explore their efficacy differences in patients with ST-segment elevation myocardial infarction(STEMI),non-ST-segment elevation myocardial infarction(NSTEMI),and different risk stratifications.Methods:A single-center,retrospective cohort study was conducted,involving 86 patients who underwent percutaneous coronary intervention(PCI)for AMI between January 2023 and July 2025.Patients were divided into a DCB group(n=26)and a DES group(n=60)based on the treatment modality.According to the Killip classification of myocardial infarction at admission,patients were categorized into a low-risk group(Killip Class I,n=68)and a high-risk group(Killip Classes II-IV,n=18).The primary efficacy endpoint was targeting lesion restenosis as shown by coronary angiography follow-up(6-12 months).Safety endpoints included acute in-stent thrombosis during hospitalization(ARC criteria)and long-term coronary slow flow.A multivariate logistic regression model was used to evaluate the associations between intervention modality,risk stratification,infarction type,and endpoint events,and to test for interactions.Results:The DCB and DES groups were generally balanced in terms of baseline traditional risk factors.During hospitalization,three cases(5.0%)of acute in-stent thrombosis occurred in the DES group,all requiring urgent re-intervention,while no such events occurred in the DCB group(0%).Acute in-stent thrombosis formation was significantly associated with high-risk stratification(χ2 test,p=0.047).The overall restenosis rate was 22.1%(19/86).Multivariate analysis showed no statistically significant difference in restenosis risk between the intervention modalities(DCB vs.DES)(adjusted odds ratio[OR]=1.07,95%confidence interval[CI]0.27-4.21,p=0.920),and no statistical differences were found in subgroups based on risk stratification(p=0.382)or infarction type(p=0.484).There was a trend toward increased restenosis risk in high-risk patients(OR=12.34),but the difference was not statistically significant(95%CI 0.28-542.75,p=0.193).The incidence of long-term coronary slow flow was significantly higher in the DES group than in the DCB group(16.7%vs.3.8%,Fisher’s exact test,p=0.048),with a statistically significant difference.Conclusion:For AMI patients,DCBs demonstrate similar efficacy to DESs in preventing restenosis.However,DESs are associated with a higher risk of acute thrombosis during hospitalization,especially in high-risk patients,and a higher risk of long-term slow coronary flow.DCBs exhibit superior perioperative and long-term safety compared to DESs.Given the limited sample size,particularly the small number of high-risk patients and those treated with DCBs,the conclusions require validation through larger-scale prospective studies.
