A Single-Center, Retrospective, Propensity-Score-Matched Cohort Study Comparing Drug-Coated Balloon Versus Drug-Eluting Stent for Reducing Immediate Post-Procedural Slow-Flow/No-Reflow in Acute ST-Elevation Myocardial Infarction Patients With High Thrombus Burden

Comparison Of Drug-Coated Balloon Versus Drug-Eluting Stent In STEMI Patients With High Thrombus Burden: A Single-Center Retrospective Study Using Propensity Score Matching

This is a single-center, retrospective, propensity-score-matched observational study. It aims to compare the rate of immediate slow-flow or no-reflow after percutaneous coronary intervention (PCI) between drug-coated balloon (DCB) and drug-eluting stent (DES) in STEMI patients with high thrombus burden. Medical records of eligible patients admitted between January 1, 2019 and June 30, 2025 will be reviewed. Propensity-score matching will be used to balance baseline characteristics of the two groups. Both procedural-related outcomes and 1-year clinical follow-up events will be analyzed.

Inclusion Criteria:

1. Patients diagnosed with ST-elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI) at this center:

   • Symptom onset ≤ 12 hours; OR
   • Symptom onset > 12 hours with persistent ischemic symptoms.

2. Angiographic thrombus grade of the culprit vessel is G2-G4.

3. Reference vessel diameter of the culprit vessel: 2.25-4.0 mm.

4. Complete pre-procedural and post-procedural coronary angiographic imaging data are available.

5. Age ≥ 18 years old.

Exclusion Criteria:

1. Participation in other clinical trials.
2. Cardiogenic shock or post-cardiac-arrest resuscitation state.
3. Multi-vessel coronary artery disease.
4. Severe calcified lesions requiring rotational atherectomy or shock-wave therapy.
5. Only compliant or non-compliant plain balloon dilation performed.
6. Both DES and DCB applied to the same culprit vessel.
7. Culprit lesion located in a coronary bypass graft, or in-stent restenosis / in-stent thrombosis.
8. Missing key angiographic or clinical follow-up data.