Sirolimus-Coated Balloon Versus Drug-Eluting Stent in Elderly Patients With Coronary Artery Disease: A Matched-based Comparison

Coronary artery disease (CAD) is the leading cause of mortality in elderly patients (≥75 years). While percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (DES) is commonly used in elderly patients with CAD, drug-coated balloons (DCB) have emerged as a promising alternative. The aim of this study was to compare the safety and efficacy of PCI with Sirolimus-Coated Balloons (SCB) and second-generation DES in this population. We included elderly patients who underwent PCI from the prospective, investigator-driven EASTBOURNE study (n= 534 patients treated with Magic Touch SCB) and the Complex Registry (n = 234 patients treated with second-generation DES). The primary endpoint was net adverse cardiovascular events (NACE), a composite of all-cause death, target lesion revascularization (TLR), nonfatal myocardial infarction (MI), and major bleedings at the 2-year follow-up. The cardinality score matching and Cox regression analysis were employed. After matching, 220 patients were included in each group. The incidence of NACE was similar between groups (HR 1.28; 95% CI: 0.85-1.93; p = 0.239). No significant differences were observed in the rates of nonfatal MI, or TLR. However, the SCB group exhibited a significantly lower rate of the secondary BARC 3-5 bleeding endpoint compared to the DES group (HR 0.17; 95% CI: 0.04-0.77; p = 0.030). In conclusion, CI with SCB demonstrated comparable safety and efficacy to second-generation DES in elderly patients with CAD at 2-year follow-up, with a notable reduction in major bleeding risk in the SCB group.