The REC-CAGEFREE I trial recently conducted in China compared the outcomes of drug-coated balloon (DCB) angioplasty versus stenting as the initial strategy for de novo coronary artery stenoses. The results of the trial, presented at the European Society of Cardiology (ESC) meeting and published in The Lancet, revealed that DCB with rescue use of drug-eluting stents (DES) did not perform as well as intended stenting. The composite 24-month rate of cardiovascular death, target vessel myocardial infarction (MI), and target lesion revascularization was nearly doubled in the DCB group compared to the stenting group. These findings suggest that DES implantation should remain the preferred treatment strategy in current practice.
Dr. Ling Tao, the lead researcher of the REC-CAGEFREE I trial, highlighted the challenges associated with using DCB as the initial strategy for coronary artery stenoses. The significantly higher risk of adverse cardiovascular events in the DCB group, particularly in non-small vessel disease, indicates that DCB may not be as effective in certain patient populations. The need for larger device diameters and the possibility of higher rates of revascularization further underscore the limitations of DCB compared to DES. These findings emphasize the importance of carefully selecting the most appropriate treatment strategy for each patient.
Despite the unfavorable outcomes observed in the REC-CAGEFREE I trial, there are still opportunities for further research and exploration in the field of coronary artery interventions. Dr. Tao suggested investigating lesion types that may be suitable for treatment without stenting, such as bifurcation lesions or those with fibrosis. Additionally, the development of DCB that deliver a more sustained drug dose could potentially improve outcomes and reduce the need for rescue stenting. Long-term follow-up studies are also needed to determine whether late events can be prevented by DCB and whether the higher rate of revascularization translates into improved mortality or MI rates.
The results of the REC-CAGEFREE I trial have important implications for clinical practice in the management of coronary artery stenoses. While DCB has shown promise in some cases, the data suggest that DES implantation remains the preferred treatment strategy for most patients. Healthcare providers should carefully evaluate the characteristics of each lesion and consider the potential benefits and risks of using DCB versus stenting. More research is needed to clarify the optimal use of DCB in specific patient populations and to address the limitations identified in the trial.
The REC-CAGEFREE I trial provides valuable insights into the outcomes of DCB angioplasty versus stenting for de novo coronary artery stenoses. The findings underscore the importance of choosing the right treatment strategy based on individual patient characteristics and lesion complexity. Further research and long-term follow-up studies are essential to optimize the use of DCB in clinical practice and improve outcomes for patients with coronary artery disease.
Leave a Reply