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Acute Coronary Syndrome vs Chronic Coronary Syndrome Drug-Eluting Balloon PCI: A Lesion-Level Analysis of Predictors and Outcomes of Target Lesion Failure
Session:
Sessão de Posters 06 - Balões revestidos na ICP contemporânea
Speaker:
Lucas Hamann
Congress:
CPC 2026
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Posters Eletrónicos
FP Number:
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Authors:
Lucas Hamann; J.Guerreiro Pereira; D. Faria; S. Andraz; J. Massa Pereira; H. Costa; P. Azevedo; P. Franco; J. Moura Guedes; J. Bispo; J. Mimoso; H. Vinhas
Abstract
<p>Background: Drug-eluting balloon (DEB) angioplasty is increasingly used across the spectrum of chronic coronary syndromes (CCS) and acute coronary syndromes (ACS), but comparative lesion-level data for ACS versus CCS procedures are limited.</p> <p>Purpose: To compare lesion-level outcomes between ACS and CCS DEB percutaneous coronary intervention (PCI) and to identify independent predictors of target lesion failure (TLF).</p> <p>Methods: We conducted a retrospective single-centre analysis of 398 consecutive patients (mean age 67.1±12.6 years, 83.2% male), from 2023 and 2024, treated with DEB, yielding 518 DEB-treated lesions with a follow-up of more than 1 year. Hypertension, dyslipidaemia and diabetes were present in 77.4%, 78.4% and 38.2% of patients, respectively. Baseline presentation was STEMI in 21.4%, NSTEMI 29.1%, unstable angina 4.3% and chronic coronary syndrome 45.0%. ACS (STEMI/NSTEMI/UA for 271 lesions (52.3%), whereas 247 lesions (47.7%) were CCS. Lesion complexity was frequent (bifurcation 40.9%, de novo 75.5%, in-stent restenosis 24.9%). The primary endpoint was lesion-level TLF (composite of TLR and non-TLR events including MI/CV death); secondary endpoints were TLR and TLF components. Univariate comparisons (Fisher’s exact test) and penalised multivariable logistic regression were performed.</p> <p>Results: Over follow-up, TLF occurred in 12/271 ACS lesions (4.43%) versus 2/247 CCS lesions (0.81%; odds ratio [OR] 5.68, p=0.013). In contrast, TLR rates were low and similar (0.74% ACS vs 0.81% CCS, OR 0.91, p=1.000). Subanalysis of TLF components and secondary outcomes showed increased cardiovascular death (2.95% vs 0.81%, p=0.110) and all-cause death (4.43% vs 2.04%, p=0.146), while follow-up MI rates were comparable (2.58% vs 2.02%, p=0.775), as well as numerically higher non-TLR events in ACS lesions (18.1% vs 12.6%, p=0.089). In multivariable analysis, ACS presentation remained an independent predictor of TLF (adjusted OR 6.15, 95% CI 1.66–22.82; p=0.007), and bifurcation lesions were also associated with higher TLF risk (adjusted OR 4.48, 95% CI 1.30–15.44; p=0.018); other lesion characteristics, AHA class and segment location were not significant.</p> <p>Conclusion: In this real-world lesion-level cohort, ACS DEB PCI was associated with a higher risk of TLF, predominantly due to increases in target-vessel MI and cardiac death, with no significant difference in TLR compared with CCS interventions. These findings support careful procedural planning and optimal lesion preparation when treating ACS with DEBs, particularly in bifurcation lesions, where the combined biological and anatomical complexity compounds risk. Prospective studies are needed to further refine the role of DEBs in the ACS PCI setting.</p> <p> </p>
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