Clinical impact of optical coherence tomography findings after drug-coated balloon treatment for patients with acute coronary syndromes

• Published in: International journal of cardiology 2023-09, Vol.387, p.131149-131149, Article 131149
• Main Authors: Yamamoto, Tetsuya, Kawamori, Hiroyuki, Toba, Takayoshi, Kakizaki, Shunsuke, Nakamura, Koichi, Fujimoto, Daichi, Sasaki, Satoru, Fujii, Hiroyuki, Hamana, Tomoyo, Osumi, Yuto, Iwane, Seigo, Naniwa, Shota, Sakamoto, Yuki, Matsuhama, Koshi, Fukuishi, Yuta, Kozuki, Amane, Shite, Junya, Iwasaki, Masamichi, Ishida, Akihiko, Hirata, Ken-ichi, Otake, Hiromasa
• Format: Article
• Language: English
• Subjects: Acute coronary syndrome; Drug-coated balloon; Optical coherence tomography; Plaque morphology; Target lesion failure; Thrombus
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2023.131149

Drug-coated balloon (DCB) became a potential treatment option for patients with acute coronary syndrome (ACS); however, factors associated with target lesion failure (TLF) remain uncertain. This retrospective, multicentre, observational study included consecutive ACS patients who underwent optical coherence tomography (OCT)-guided DCB treatment. Patients were divided into two groups according to the occurrence of TLF, a composite of cardiac death, target vessel-related myocardial infarction, and ischemia-driven target lesion revascularisation. We enrolled 127 patients in this study. During the median follow-up period of 562 (IQR: 342–1164) days, 24 patients (18.9%) experienced TLF, and 103 patients (81.1%) did not. The cumulative 3-year incidence of TLF was 22.0%. The cumulative 3-year incidence of TLF was the lowest in patients with plaque erosion (PE) (7.5%), followed by those with rupture (PR) (26.1%) and calcified nodule (CN) (43.5%). Multivariable Cox regression analysis revealed that plaque morphology was independently associated with TLF on pre-PCI (percutaneous coronary intervention) OCT, and residual thrombus burden (TB) was positively associated with TLF on post-PCI OCT. Further stratification by post-PCI TB revealed a comparable incidence of TLF in patients with PR (4.2%) to that of PE if the culprit lesion had a smaller post-PCI TB than the cut-off value (8.4%). TLF incidence was high in patients with CN, regardless of TB size on post-PCI OCT. Plaque morphology was strongly associated with TLF for ACS patients after DCB treatment. Residual TB post-PCI might be a key determinant for TLF, especially in patients with PR. •DCB is an option for specific lesion subsets in patients with ACS.•Potential difficulties exist with angiography-based patient and lesion selection.•Plaque morphology and residual TB may enable risk stratification.•DCB could be considered an effective treatment for patients with PE.•Stent implantation may be preferred if the residual TB is large in lesions with PR.