Application value of drug-coated balloons in elderly patients with acute non-ST segment elevation my-ocardial infarction

Zhang Lijing; Sun Wenchao; Qiao Weitong

doi:10.3969/j.issn.1674-4055.2024.10.11

Abstract：Objective To investigate the efficacy and safety of using drug-coated balloons(DCB)in the culprit vessels of elderly patients with non-ST-segment elevation myocardial infarction(NSTEMI).Methods Elderly patients with acute non-ST-segment elevation myocardial infarction(NSTEMI)who underwent percutaneous coronary intervention(PCI)at the Department of Cardiovascular Medicine,First Affiliated Hospital of Xiamen University,from February 2017 to June 2021,were included in the study.They were randomly divided into the drug-coated balloon group(DCB group,n=60)and the drug-eluting stent group(DES group,n=62).We compared the basic clinical data,coronary lesions,and the amount of contrast agent used during PCI;compared the luminal changes of the criminal vessels during PCI and 12-month follow-up after PCI,and compared major adverse cardiac events(MACE)and all bleeding in the two groups within one year of follow-up.Results The amount of contrast agent used during PCI showed no statistical difference between the two groups(P=0.157).No significant differences were observed in the reference vessel diameter(RVD)and minimum lumen diameter(MLD)of the target lesions between the two groups before the procedure(P＞0.05).However,the immediate post-PCI MLD[(2.76±0.78)mm vs.(3.18±1.01)mm,P=0.012]and acute lumen gain(ALG)[(1.90±0.32)mm vs.(2.03±0.26)mm,P=0.015]were both found to be smaller in the DCB group compared to the DES group,with statistically significant differences.Less late lumen loss(LLL)was observed in the DCB group compared to the DES group[(0.76±1.26)mm vs.(1.31±1.73)mm,t=2.111,P=0.037],showing a statistically significant difference.No statistical difference was found in the overall major adverse cardiac events(MACE)within 12 months of follow-up between the two groups(P＞0.05).However,the incidence of bleeding events was significantly lower in the DCB group compared to the DES group(5.00％vs.17.74％,x2=4.873,P=0.027),with no fatal bleeding events observed in either group.Conclusions Management of target vascular lesions in elderly NSTEMI with DCB only provides good safety and benefit for patients and is a safe and effective alternative for elderly NSTEMI patients with a high risk of bleeding and organ failure.