Drug-Coated Balloon Versus Drug-Eluting Stent for Coronary Revascularization in Patients With Chronic Kidney Disease: A Real-World Propensity-Matched Study

Chronic kidney disease (CKD) is associated with adverse outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Drug-coated balloons (DCB) have emerged as a promising stentless alternative. This study aimed to compare the clinical outcomes of DCB-only PCI versus current-generation DES in patients with CKD. This pooled analysis integrated data from seven observational studies. The DCB cohort included the EASTBOURNE, Milan-DCB, RISE, and DRAGON registries. The DES cohort comprised the ULISSE, ASTUTE, RUDIFREE, and DRAGON registries. The study population included 1.732 patients with CKD (eGFR <60 ml/min/1.73 m2), of whom 765 were treated with DCB and 967 with DES. The primary endpoint was major adverse cardiovascular events (MACE). Propensity score matching was applied to balance clinical and angiographic features. In the matched population (460 patients per group), the rate of MACE was similar between the two groups (hazard ratio [HR]: 1.09, 95% confidence interval: 0.71 to 1.66) at a mean follow-up of 564 days. DCB treatment was associated with a significantly lower incidence of Bleeding Academic Research Consortium major bleeding (HR 0.13; 95% confidence interval 0.03 to 0.48; p < 0.001). DCB-based PCI was associated with a lower risk of MACE in small-vessel disease (HR: 0.54; p for interaction = 0.04) and long (>= 30 mm) lesions (HR: 0.44; p for interaction = 0.02). DCB treatment was associated with comparable rates of MACE at mid-term follow-up and a significantly lower incidence of major bleeding compared to current-generation DES in patients with CKD. These insights may facilitate a personalized revascularization approach in CKD patients. (c) 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.