Physiology-guided percutaneous coronary intervention using drug-coated balloon versus drug-eluting stent: a propensity-matched analysis

Background: Physiology-guided drug eluting stent percutaneous coronary intervention (ph DES-PCI) improves cardiovascular outcomes; however, the clinical benefit of ph drug coated balloon PCI (ph DCB-PCI) remains unclear. Results: A propensity-matched analysis of 39 patient pairs (ph DCB-PCI versus ph DES-PCI) from the PROPHET-FFR registry was performed. At 13  months, the MACE rate was similar between the groups (5.1 versus 7.6%, P = 0.644), principally driven by target-vessel revascularization (2.6 versus 7.6%, P = 0.305). A single periprocedural myocardial infarction occurred in the ph DCB-PCI group (P = 0.314). Major findings: Ph DCB-PCI appears feasible in selected patients, with no apparent signal of worse outcomes compared with ph DES-PCI, supporting a potential role for physiological assessment in stentless revascularization strategies.