Drug-Coated Balloons in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry.

Background: There is limited information on the use of drug-coated balloons (DCBs) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

Aims: To assess the frequency and outcomes of DCB use in CTO PCI.

Objective: This study evaluated the frequency and outcomes of DCB use in a large, multicenter CTO PCI registry.

Methods: We analyzed 12,146 patients who underwent 12,157 successful CTO PCIs at 59 centers from 2018 to 2025.

Results: DCBs were used in 454 patients (3.7%) with increasing frequency over time (p = 0.020). A DCB-only strategy was used in 48.4% of the patients and a hybrid strategy combining DCBs and drug-eluting stents (DES) was used in 51.6% of patients. Patients treated with DCB (both strategies) had low prevalence of comorbidities. Compared with the DES cases, DCB only cases had favorable angiographic characteristics, lower mean J-CTO (Japanese CTO) score (1.83 ± 1.03 vs. 2.27 ± 1.23; p < 0.001), and similar technical success (96.3% vs. 97.3%; p = 0.640), and in-hospital major adverse cardiac events (MACE). The hybrid and DCB-only strategies had comparable technical success and in-hospital MACE. During a median follow-up of 323 (170-429) days, DCB only cases had lower MACE than the other strategies (hazard ratio [HR] 0.41, 95% CI 0.17-0.96, p = 0.040). After multivariable adjustment, the association remained significant (HR 0.39, 95% CI 0.16-0.92, p = 0.032).

Conclusions: DCBs are increasingly being used in CTO PCI. A DCB only strategy was used in less complex lesions and was associated with similar technical success and in-hospital MACE compared with hybrid or DES strategies. A DCB only strategy was associated with lower long-term MACE.