BackgroundPercutaneous coronary intervention (PCI) with drug-eluting stents (DES) is effective for ischemic heart disease. However, patients on dialysis experience a significantly higher incidence of re-intervention than non-dialysis patients due to increased rate of progression of native disease and increased in-stent restenosis (ISR). While drug-coated balloon (DCB) angioplasty is a safe treatment for de novo coronary lesions in the general population, the effectiveness of DCB angioplasty for de novo lesions in patients with end-stage renal failure (ESRD) on replacement therapy remains unclear. This study aims to evaluate the efficacy of DCB angioplasty compared to DES angioplasty in treating de novo coronary artery lesions in patients on dialysis.

MethodsThis is a retrospective observational cohort study involving 130 consecutive patients on dialysis submitted to percutaneous coronary intervention (PCI) to de novo lesions between January 2020 and September 2023, at a single centre. All patients had end-stage renal disease (ESRD) and were on maintenance dialysis prior to PCI; 44 received DCB (DCB group) and 86 received drug-eluting stents (DES group) at the operators. discretion The primary endpoint was target lesion revascularization (TLR) within 12 months, while secondary endpoints included cardiac death, myocardial infarction, target lesion thrombosis (TLT), major bleeding, and major adverse cardiac events (MACE).

ResultsThe mean participant age was 59 ± 11 years, with no significant differences in age, hypertension, or dialysis duration between the DES and DCB groups. Most lesions were located in the LAD (70%), followed by the RCA (23.8%). Average vessel diameter was 2.96-3.14 mm. Intravascular imaging was used in 54.6% of cases. TLR rates were comparable (DES 6.9% vs. DCB 3.9%, P = 1.00), confirmed by propensity score matching and TLR-free survival rate is shown in figure 1. No TLT was observed in the DCB group, whereas stent thrombosis occurred in 1 DES patients (1.16%). MACE rates were similar (DES 22.1% vs. DCB 18.2%, P = 0.21), with major bleeding reported in 7 DES cases (5.3%) and none in the DCB group (P = 0.55).

ConclusionThe efficacy and safety of DCB angioplasty for de novo coronary lesions in patients with ESRD on dialysis were similar to those of DES angioplasty in the real world. In our population, angioplasty with DCB can be an acceptable treatment for this challenging set of patients.