Drug-Coated Balloons Versus Drug-Eluting Stents for De Novo Ostial Left Circumflex Lesions: The International Multicenter DCB-CIRCO Registry

Background: Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) on ostial left circumflex (oLCx) is associated with a high rate of adverse events. Aims: This study aims to compare drug-coated balloons (DCB) and DES in the treatment of oLCx lesions. Methods: Consecutive patients undergoing DCB-PCI of de novo oLCx lesions (isolated or in the context of a distal left main bifurcation) in eight international centers from 2018 to 2023 were retrospectively enrolled and compared with a historical cohort of patients who received PCI with DES. The primary endpoint was the 2-year incidence of target lesion failure (TLF), a composite of target lesion revascularization (TLR), target vessel-myocardial infarction and cardiac death, at time-to-first event analysis. Propensity-score matching was adopted to adjust for clinical and angiographic confounders. Results: A total of 152 patients were included in the DCB group and 351 patients in the DES group. Patients in the DES group had more multivessel disease (94.6% vs. 82.7%, p < 0.001) but shorter lesions (18.0 [interquartile range, IQR: 15.0−28.0] vs. 25.5 [17.4−40.0] mm, p < 0.001) than those in the DCB group. Fluoroscopy time (20.0 [IQR: 14.0−28.2] vs. 31.0 [21.0−45.5] min, p < 0.001) and amount of contrast used (150 [IQR: 120−220] vs. 200 [140−250] mL, p = 0.006) were significantly lower in DCB-PCI than DES-PCI. The 2-year rate of TLF was similar in the two groups (19.0% in the DCB group vs. 19.8% in the DES group, hazard ratio [HR]: 1.05, 95% confidence interval [CI] 0.64−1.75). This result remained consistent in the 126 pairs of patients obtained after propensity score matching. Conclusions: In a multinational observational retrospective real-world study including patients undergoing PCI on oLCx, no difference in TLF rate was detected between PCI with DCB and PCI with DES at a midterm follow-up.