Drug-Coated Balloons Versus Drug-Eluting Stents for Side Branch Lesions in Coronary Bifurcations: An Updated Comparative Meta-Analysis

Quevedo-Candela F.; Cieza T.; Ruhl A.; Nolte C.; Bertrand O.F. · American Journal of Cardiology (2026) · DOI: 10.1016/j.amjcard.2026.03.041

Resumen

The management of side branch (SB) lesions in true coronary bifurcations remains controversial, particularly regarding long-term risks associated with metallic implants. Drug-coated balloons (DCB) have emerged as an alternative to drug-eluting stents (DES), offering a scaffold-free approach that may simplify percutaneous coronary intervention (PCI) and reduce adverse events. We performed a systematic review and meta-analysis of randomized and observational studies directly comparing placlitaxel DCB and limus-eluting DES for SB treatment. The primary endpoint was major adverse cardiac events (MACE) including cardiovascular death, target vessel myocardial infarction (TV-MI), and clinically driven target lesion revascularization (TLR); secondary endpoints included target lesion revascularization, binary restenosis, myocardial infarction, and all-cause or cardiovascular mortality. Risk of bias was assessed using RoB 2 and Newcastle–Ottawa tools. Five studies (n = 898) were included. In pooled random-effects analyses, DCB use was associated with a significant reduction in MACE (odds ratio 0.48, 95% confidence interval 0.27 to 0.81; p = 0.008) and target lesion revascularization (odds ratio 0.35, 95% confidence interval 0.19 to 0.68; p = 0.001). Late lumen loss was significantly lower with DCB across studies. In conclusion, placlitaxel DCBs therefore appeared to be an effective alternative to DES for SB lesions in true bifurcations. Larger randomized trials are still required to confirm these findings and clarify their role in bifurcation (side branch) PCI.