Drug-coated balloons for acute coronary syndromes

Drug-coated balloon (DCB)-only angioplasty is a rapidly expanding area of both clinical interest and research in the field of coronary intervention. Randomised clinical trials (RCTs) and registries have shown the non-inferiority of DCB-only percutaneous coronary intervention (PCI), as compared with routine, standard-of-care drug-eluting stent (DES) implantation, in a number of clinical settings and lesion types. However, the most high-risk and possibly most complex angioplasty that is often done is in the setting of an acute coronary syndrome (ACS), particularly ST-elevation myocardial infarction (STEMI) primary PCI (PPCI) or out-of-hospital cardiac arrest (OOHCA) (Figure 1). There are limited data available for the use of DCBs in the setting of an ACS; we will review this along with the potential advantages and disadvantages of adopting a DCB approach.

There are a large number of case reports on the use of DCBs in ACS patients, as well as data from RCTs including subgroup analyses. The first studies, such as PAPPA or DEB-AMI, investigated the concept of combining DCBs with bare metal stents (BMS), a concept that has largely been abandoned today. The randomised...