Drug‐Coated Balloons Versus Non‐Coated Balloons for Side Branch Treatment in Bifurcation Lesions: A Systematic Review and Meta‐Analysis

Background: Coronary bifurcation lesions (CBL) account for ~20% of percutaneous coronary interventions (PCI). When using provisional stenting, optimal management of a diseased side branch (SB) remains debated. Drug-coated balloons (DCBs) are an emerging option, but data on their role in CBL PCI are limited. Aims: We conducted a meta-analysis to compare DCBs and non-compliant balloons (NCBs) for SB treatment. Methods: A systematic search of MEDLINE, CENTRAL, and EmBase (until November 2024) identified studies comparing DCBs and NCBs for treating the SB. From 1451 studies, five were included (two randomized controlled trials [RCTs], three observational), with 1762 patients, predominantly male with acute coronary syndrome (ACS). The primary outcome was major adverse cardiac events (MACE); secondary outcomes included myocardial infarction (MI), target lesion revascularization (TLR), and target vessel revascularization (TVR). Results: DCBs significantly reduced MACE (pooled OR 0.48, 95% CI 0.34–0.68, p < 0.0001, I² = 0%) and MI (pooled OR 0.39, 95% CI 0.25–0.62, p < 0.001, I² = 0%) compared to NCBs. No significant differences were observed in TLR or TVR. Subgroup analysis confirmed consistency across observational studies and RCTs for MACE and MI. Conclusions: DCBs in SB treatment during CBL PCI are associated with reduced MACE and MI compared to NCBs, with no significant differences in vessel-specific outcomes. These findings suggest a potential clinical benefit of DCBs in reducing ischemic events, while limiting stenting in CBL. Further research is needed to refine patient selection and optimize outcomes.