Long‐Term Clinical Outcomes of Drug‐Coated Balloon Following Directional Coronary Atherectomy for Bifurcated or Ostial Lesions in the DCA/DCB Registry

ABSTRACT Background The long‐term efficacy of drug‐coated balloon (DCB) angioplasty for large bifurcation lesions, particularly those involving the left main trunk (LMT), remains unclear. Aims This study aimed to evaluate the long‐term outcomes of directional coronary atherectomy followed by DCB (DCA/DCB) for large bifurcation lesions. Methods This retrospective multicenter study analyzed 129 cases from the DCA/DCB registry, with 80.4% involving LMT bifurcation lesions. Building on previously reported 12‐month outcomes, this study assessed long‐term results. The primary endpoint was clinically driven (CD) target lesion revascularization (TLR) at 36 months. Secondary endpoints included CD target vessel revascularization (TVR); CD target vessel failure (TVF); and adverse events, such as all‐cause mortality, cardiac death, target vessel acute myocardial infarction (AMI), and the need for coronary artery bypass grafting (CABG), at 24 and 36 months. Results The mean follow‐up was 53.4 ± 23.9 months. The CD‐TLR rate was 5.0% at 24 months, and the primary endpoint was 5.9% at 36 months. CD‐TVR rates were 14.0% at 24 months and 15.0% at 36 months, while CD‐TVF rates were 14.9% at 24 months and 16.7% at 36 months. Adverse events included all‐cause mortality rates of 0.8% at 24 months and 1.8% at 36 months, and cardiac death rates of 0.8% at both 24 and 36 months. No target vessel AMI or CABG procedures were reported. Conclusion The consistently low CD‐TLR rate at 36 months supports the efficacy of the DCA/DCB strategy for large bifurcation lesions, including LMT, indicating its sustained effectiveness. These findings highlight the viability of this treatment approach.