Drug Coated Balloon vs. Drug Eluting Stent in Multiculprit Primary Percutaneous Revascularization

Background: Patients presenting with ST-elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PCI) frequently face multivessel coronary artery disease (CAD). The optimal interventional approach remains debated. Objective: To systematically review and analyze the effectiveness and safety of drug-coated balloons (DCB) versus drug-eluting stents (DES) in multiculprit primary PCI through a randomized controlled trial. Methods: This prospective, single-center, randomized controlled trial included 100 patients with STEMI and multivessel CAD at Lady Reading Hospital Peshawar from April 2023 to March 2024. Patients aged 18 years or older requiring revascularization of two or more culprit lesions were randomized into two groups: one received DCBs and the other DES. Exclusions were based on contraindications to dual antiplatelet therapy, allergies to study drugs, bleeding disorders, or life expectancy under one year. Results: Each group comprised 50 patients. The prevalence of hypertension (56% in DCB vs. 60% in DES, p=0.68) and diabetes (36% in DCB vs. 40% in DES, p=0.72) was similar. TVR rates were 10% for DCB and 8% for DES (p=0.45). MACE rates were 14% for DCB and 12% for DES (p=0.37). Conclusion: The study supports the use of DCB as an alternative to DES in specific clinical scenarios, emphasizing the need for tailored treatment decisions based on individual patient and lesion characteristics.