48 Drug coated balloon only angioplasty for STEMI

Introduction In the setting of primary percutaneous coronary intervention (PPCI), it has been shown that stenting compared to balloon angioplasty (BA) reduces the need for repeat revascularisation but not overall mortality. A recent, small randomised trial showed that drug coated balloon (DCB) angioplasty for PPCI was non-inferior to drug eluting stent (DES) in terms of fractional flow reserve at 9 months. Our aim was to investigate the safety of DCB angioplasty in a STEMI population in terms of all-cause mortality. Methods We identified all patients treated for STEMI in our institution from January 2016 until November 2019. We excluded patients who died in hospital and patients with cardiac arrest, cardiogenic shock or requiring intubation; given that their mortality is more likely to be determined by the severity of their clinical presentation rather than the PCI strategy. The primary endpoint was all-cause mortality. Survival data were obtained through the UK Health and Social Care Information Service. Clinical and angiographic data were collected from our prospectively collated database and supplemented from electronic records where required. All angiograms were reviewed by an experienced operator to confirm treatment strategy, bifurcation lesions, coronary artery dissection and TIMI flow pre- and post-intervention. Results A total of 1190 patients were identified; 470 treated with DCB and 720 with DES. The average age for the DCB group was 65.5 ± 12.5 years old (73.6% male); while for the DES group it was 65.5 ± 11.6 years old (74.7% males). The average follow up was 882 ± 439 days and 978 ± 426 days for the DCB and DES group respectively. There were a few differences between the groups (table 1). There were no differences in all other clinical and angiographic characteristics. The all-cause mortality was 33/470 (7%) for the DCB group and 48/720 (6.7%) for the DES group. Kaplan Meier estimator plot for all-cause mortality (figure 1) did not show a significant difference between DCB and DES (p=0.54). On multivariable Cox regression analysis (table 2), age, prior stroke, coronary artery bypass graft, heart failure, chronic obstructive pulmonary disease (COPD) and diabetes were significant poor predictors of mortality. Conclusion Our real-world data from a large, contemporary cohort of STEMI patients demonstrate that DCB only angioplasty is safe compared to DES and may be considered as a treatment option. Conflict of Interest none