Paclitaxel-eluting stents versus paclitaxel-coated balloons in coronary artery disease: a meta-analysis of randomized controlled trials

Abstract

The efficacy of drug-coated balloons (DCB) versus drug-eluting stents (DES) for coronary artery disease (CAD) remains inconclusive. Despite paclitaxel's common use in both DES and DCB, there is a lack of meta-analyses comparing paclitaxel-eluting stents (PES) and paclitaxel-coated balloons (PCB). This meta-analysis aims to evaluate and compare DES and DCB outcomes using paclitaxel. A Systematic literature search in Medline and Cochrane databases yielded six randomized controlled trials with 951 patients (1:1 ratio). Primary endpoints were mortality, target lesion vascularization (TLV), myocardial infarction (MI), target vessel revascularization (TVR), and major adverse cardiovascular events (MACEs). Secondary endpoints included in-device binary stenosis, in-segment binary stenosis, late luminal loss (LLL), post minimal lumen diameter (MLD), and post diameter stenosis. Within the study populations, the incidence of previous MI was significantly lower in the PES group compared to the PCB group (26.70% vs. 39.22%, OR:0.56, 95%CI:0.41–0.76, p=0.0002).  The meta-analysis results showed that mortality (OR:1.57, 95%CI:0.67-3.66, p=0.29), TLV (OR:0.74, 95%CI:0.37-1.48, p=0.39), MI (OR:1.76, 95%CI:0.79-3.88, p=0.16), TVR (OR:0.76, 95%CI:0.51-1.12, p=0.16), and MACEs (OR:1.11, 95%CI:0.48-2.58, p=0.81) did not exhibit significant differences between PES and PCB group in CAD. Furthermore, in stent or in balloon binary stenosis (OR:0.80, 95%CI:0.34-1.87, p=0.60), in segment binary stenosis (OR:1.16, 95%CI:0.48-2.80, p=0.74), LLL (MD:0.03, 95%CI:-0.11 to 0.17, p=0.65), post MLD (MD:0.04, 95%CI:-0.23 to 0.30, p=0.77), and post diameter stenosis (MD:-5.48, 95%CI:-13.88 to 2.92, p=0.20) were similar in both groups. Our comprehensive analysis concludes that both PES and PCB manifest comparable effectiveness and safety in the management of CAD.