[Comparison of clinical outcomes of DCB angioplasty versus DES implantation in patients with recently diagnosed cancer and coronary artery disease undergoing PCI].

Abstract

Objective: To investigate the difference of clinical outcomes of drug-coated balloon (DCB) angioplasty and drug-eluting stent (DES) implantation in patients with recently diagnosed cancer and concomitant coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). Methods: A total of 155 patients hospitalized in the Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University from January 2018 to December 2024 were restrspectively enrolled. All patients were definitively diagnosed with CAD via coronary angiography, underwent PCI, and had been diagnosed with cancer within 5 years prior to the current admission. Among them, 61 patients were treated with DCB and 94 with DES implantation. Demographic characteristics, cardiovascular risk factors, previous cardiovascular history, cancer type, as well as the number of diseased blood vessels, target vessels, in stent restenosis, bifurcation and small vessel lesions, use of interventional instruments, immediate postoperative blood flow, and intravascular imaging or functional evaluation of two groups of patients were collected. Continuous variables with normal distribution were compared using the independent-samples t test, whereas categorical variables were compared using Pearson's χ² test or Fisher's exact test, as appropriate. Overall survival was estimated using the Kaplan-Meier method and Log-rank test. Cardiovascular and non-cardiovascular deaths were treated as competing events, and cumulative incidence function and Gray's test were used for competitive analysis. Results: No significant between-group differences were observed in age, sex, body mass index, current smoking, dyslipidemia, hypertension, previous myocardial infarction, or chronic kidney disease (all P>0.05). The DCB group had higher proportion of diabetes mellitus, triple-vessel disease, in-stent restenosis, bifurcation lesions, and small-vessel disease, whereas the DES group had higher proportion of previous PCI, previous coronary artery bypass grafting (CABG), and left anterior descending artery interventions. Kaplan-Meier analysis demonstrated that overall survival was significantly lower in the DCB group than that in the DES group [82.0% (50/61) vs 95.7% (90/94), P=0.005]. Competive risk analysis showed that the cumulative incidences of cardiovascular death were 4.9% (3/61) in the DCB group and 3.2% (3/94) in the DES group, with no statistically significant difference (P=0.589). However, the cumulative incidence of non-cardiovascular death was significantly higher in the DCB group than that in the DES group [13.1% (8/61) vs 1.1% (1/94), P=0.002]. Conclusions: Among patients with recently diagnosed cancer and concomitant CAD undergoing PCI, DCB angioplasty was associated with lower overall survival than DES implantation, without a significant increase in cardiovascular mortality. The survival difference is mainly related to higher cumulative incidence of non-cardiovascular death. Further studies are required to establish the long-term safety of DCB angioplasty in this high-risk population.