Single vs. Dual Antiplatelet Therapy in Patients Undergoing Percutaneous Intervention With DCB-only Strategy (KONG-FREEDOM-I)

An Investigator-initiated, Multicenter, Open-label, Randomized Controlled Non-inferiority Trial to Assess the Single vs. Dual Antiplatelet Therapy in the Chronic Coronary Syndrome (CCS) and Stable Acute Coronary Syndrome (S-ACS) Patients Undergoing Percutaneous Intervention With Drug-coated Balloons (DCB)-Only Strategy (KONG-FREEDOM-I)

This investigator-initiated, multicenter, open-label, randomized clinical trial evaluates the safety and efficacy of single antiplatelet therapy (SAPT) utilizing a P2Y12 inhibitor compared to dual antiplatelet therapy (DAPT) in the chronic coronary syndrome (CCS) and stable Acute Coronary Syndrome (S-ACS) patients undergoing percutaneous coronary intervention (PCI) with the latest generation rapamycin drug-coated balloon (DCB) without stent implantation. The study aims to assess rates of ischemic and bleeding adverse events.

The purpose of the KONG-FREEDOM-I study is to evaluate the efficacy and safety of single antiplatelet therapy (SAPT) utilizing a P2Y12 inhibitor after successful PCI with the Fireliums coronary rapamycin drug-eluting balloon without stent implantation in coronary artery disease in vessels with a diameter between 2.0 and 4.5 mm, compared to routine dual antiplatelet therapy (DAPT). Patients with chronic coronary syndrome (CCS) and stable Acute Coronary Syndrome (S-ACS) will be enrolled and randomized in this study.

Inclusion Criteria:

Subjects who successfully underwent percutaneous coronary intervention (PCI) with drug-coated balloon (DCB) treatment without stent implantation are eligible for inclusion in this study if Male and female patients who meet the following criteria：

1. Age ≥ 18 years.
2. target lesion in vessels with diameter ≥2.0 and ≤4.5 mm (visual estimation).
3. the total target vessels ≤2 and a total of target lesions ≤2.
4. Total length of DCB used for target lesions <60 mm.
5. The subject's indication for PCI is chronic coronary syndrome (CCS) and stable Acute Coronary Syndrome (S-ACS), include Silent Ischemia, stable angina (SA), unstable angina (UA), non-ST-segment elevation myocardial (NSTEMI), or ST-segment elevation acute myocardial infarction (STEMI) with onset >2 weeks.
6. All lesions were successfully treated with a drug-eluting balloon during routine clinical practice, i.e., post-procedural angiographic visual diameter stenosis <30%.
7. At the operator's discretion, no flow-limiting angiographic complications requiring extension of dual antiplatelet therapy (DAPT)have occurred.
8. All PCI stages have been completed (if applicable), and no further PCI procedures are planned.

Inclusion criteria at the randomization visit within 24 hours post-index PCI:

At the time of the randomization visit (within 24 hours after successful drug-eluting balloon treatment during index PCI), the following criteria mustbe met:

The subject must have had an uneventful clinical course within 24 hours post-index PCI, i.e., no myocardial infarction,symptomatic restenosis, device-related thrombus formation, stroke, or any revascularization procedure (coronary or non-coronary)requiring extension of dual antiplatelet therapy.

Exclusion Criteria:

Patients will be ineligible if they meet any of the following criteria:

1. Stent implantation within 6 months prior to index percutaneous coronary intervention (PCI).
2. Treatment for in-stent thrombosis (IST) at the time of index PCI or within 6 months prior to it.
3. Treatment with a bioabsorbable stent at any time prior to index PCI.
4. Acute myocardial infarction with ST-segment elevation within the past two weeks.
5. True bifurcation lesions requiring treatment with two stents (Medina 1,1,1/1,0,1/0,1,1) with a branch vessel diameter≥2.5 mm (visual estimation).
6. Chronic total occlusion of the target lesion (≥3 months).
7. Unprotected left main coronary artery.
8. Thrombus present in the target lesion (imaging/visual).
9. Total length of DCB used in the target lesion ≥60 mm.
10. Active bleeding requiring medical intervention (BARC ≥2) at the time of randomization.
11. Indications for long-term oral anticoagulation therapy.
12. Life expectancy of less than 1 year.
13. Known allergy or hypersensitivity to aspirin, clopidogrel, ticagrelor, or sirolimus.
14. Currently participating in another trial and has not yet reached the primary endpoint.
15. History of asthma induced by salicylates or substances with similar effects (particularly nonsteroidal anti-inflammatory drugs).
16. Pregnant or breastfeeding women.
17. Inability to understand and follow study-related instructions or to comply with the study protocol.
18. Inability to provide written informed consent