There has been a lack of extensive research on the use of drug-coated balloon (DCB)-only strategy for the treatment of de novo left main coronary artery disease, especially in high bleeding risk (HBR) patients. Now, a new study has emphasized the potential benefits of this treatment approach, particularly in HBR patients.

The study conducted at North Karelia Central Hospital-Heart Center (Joensuu, Finland) assessed all consecutive patients who underwent percutaneous coronary intervention (PCI) for a de novo left main coronary artery lesion with a drug-coated balloon (DCB)-only strategy from August 2011 to December 2018. The primary focus was on major adverse cardiovascular events (MACEs), including cardiac death, non-fatal myocardial infarction, and target lesion revascularization (TLR). Patients were categorized into two groups depending on whether lesion preparation met the international consensus group guidelines. The study involved 66 patients, averaging 75±8.6 years in age, with 72% being male and 52% presenting acute coronary syndrome. There were no procedural mortalities or acute closures of the treated left main artery. After 12 months, the overall rates of MACE and TLR were 24% and 6%, respectively. Notably, when lesion preparation conformed to the guidelines, the MACE and TLR rates significantly decreased to 21.2% and 1.9%, respectively.

This study underscores the significance of meticulous lesion preparation in employing a DCB-only strategy for treating de novo left main coronary artery disease. It also highlights the advantages of this method, particularly for HBR patients, by potentially allowing for a shorter duration of dual antiplatelet therapy (DAPT) or eliminating the need for DAPT, thus minimizing bleeding risks. The study’s limitations include its retrospective nature, the small sample size, and a bias toward HBR, elderly, and patients with complex calcified left main lesions. Despite these drawbacks, the findings offer valuable insights into the DCB-only approach for managing left main coronary artery disease, suggesting it is a feasible alternative for HBR patients. This study contributes significantly to interventional cardiology, especially for those focused on PCI strategies for left main coronary artery disease and the care of HBR patients. It advocates for future randomized trials to compare DCB angioplasty with stenting using drug-eluting stents (DESs) to validate these results and further evaluate the advantages and limitations of the DCB-only strategy.

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