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Drug-eluting stents (DES) have long been recommended as the default device for patients undergoing percutaneous coronary intervention (PCI). Drug-Coated Balloon (DCB) angioplasty is similar to plain old balloon angioplasty procedurally, but there is an anti-proliferative medication paclitaxel-coated on the balloon.
DCB angioplasty has the following advantages compared to DES implantation: Firstly, the drug in DCB is uniformly distributed and released, whereas the drug release of DES via the stent platform is uneven -85% of the vascular wall is not covered by the stent strut. Secondly, there is no alloy in the vessel after DCB angioplasty, while the coronary stent platform and polymer might cause temporal or persistent inflammatory response leading to intimal hyperplasia. Finally, there is no metal cage restraining vessel motion after DCB, and the physiological function of coronary arteries would be maintained.
Currently, DCB constitutes an important treatment option in ISR, which is endorsed by the 2018 European Society of Cardiology Guidelines on myocardial revascularization. In addition, some interventional cardiologist has also applied DCB in de novo lesions in their clinical practice.
Diabetes is associated with worse outcomes after coronary revascularization and has been identified as an independent predictor of adverse events in patients with cardiovascular disease. Although some small sample size RCTs and observational studies have suggested that the clinical prognosis of DCB is non-inferior to the drug-eluting stent (DES), there is still a lack of evidence comparing the DCB versus DES for de novo or ISR coronary lesions in diabetic patients. The current study aims to compare the long-term efficacy of DCB to DES in de novo or ISR coronary lesions in diabetic patients.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Drug-coated balloon | Paclitaxel coated balloon |
| |
| Drug-eluting stent | Second-generation eluting stents |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Drug-coated balloon | Device | Paclitaxel is a pharmacologically active substance for anti-neointima. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Device-oriented Composite Endpoint (DoCE) | DoCE is a composite clinical endpoint of Cardiac cause death, Target vessel myocardial infarction (TV-MI), and clinically indicated target lesion revascularization (CI-TLR). | 24 months |
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| Measure | Description | Time Frame |
|---|---|---|
| POCE | POCE is a composite clinical endpoint of all-cause death, any stroke, non-fatal myocardial infarction (MI), any revascularization | 1 month, and 1, 2, 3, 5, 7, 10 years |
| All-cause death | Rates of individual components of PoCE |
Inclusion Criteria:
Exclusion Criteria:
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All diabetic patients who received PCI with one or more drug-coated balloons only or drug-eluting stents only to treat ISR or de novo lesions
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| Name | Affiliation | Role |
|---|---|---|
| Ling Tao, MD, Ph.D. | Xijing Hospital | Study Chair |
| Chao Gao, MD, Ph.D. | Xijing Hospital | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ling Tao | Xi'an | Shannxi | 710032 | China |
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| ID | Term |
|---|---|
| D003327 | Coronary Disease |
| ID | Term |
|---|---|
| D017202 | Myocardial Ischemia |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D014652 | Vascular Diseases |
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| ID | Term |
|---|---|
| D054855 | Drug-Eluting Stents |
| ID | Term |
|---|---|
| D015607 | Stents |
| D019736 | Prostheses and Implants |
| D004864 | Equipment and Supplies |
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| Drug-eluting stents | Device | Drug-eluting stent is composed of a metal stent, primer, and drug coating. |
|
| 1 month, and 1, 2, 3, 5, 7, 10 years |
| Non-fatal myocardial infarction (MI) | Rates of individual components of PoCE | 1 month, and 1, 2, 3, 5, 7, 10 years |
| Any stroke | Rates of individual components of PoCE | 1 month, and 1, 2, 3, 5, 7, 10 years |
| Any revascularization | Rates of individual components of PoCE | 1 month, and 1, 2, 3, 5, 7, 10 years |
| Device-oriented Composite Endpoint (DoCE) | Rates of the DoCE beside the time point of primary endpoint | 1 month, and 1, 2, 3, 5, 7, 10 years |
| Cardiac cause death | Rates of individual components of the DoCE | 1 month, and 1, 2, 3, 5, 7, 10 years |
| Target vessel myocardial infarction (TV-MI) | Rates of individual components of the DoCE | 1 month, and 1, 2, 3, 5, 7, 10 years |
| Clinically indicated target lesion revascularization (CI-TLR) | Rates of individual components of the DoCE | 1 month, and 1, 2, 3, 5, 7, 10 years |
| Target vessel failure (TVF) | Target vessel failure, defined as cardiovascular death, TV MI and clinically-indicated target vessel revascularisation | 1 month, and 1, 2, 3, 5, 7, 10 years |