Patients with chronic kidney disease undergoing percutaneous coronary intervention face elevated bleeding risk, yet data on drug-coated balloon (DCB)-based strategies in this population are limited. This retrospective study published in the American Journal of Cardiology compared bleeding and cardiovascular outcomes between DCB-based PCI and second-generation drug-eluting stent (DES)-only PCI in patients with CKD.

A total of 415 consecutive patients with CKD (defined as estimated glomerular filtration rate <60 mL/min/1.73m²) treated with DCB-based PCI were propensity score-matched (1:1) to 415 patients undergoing DES-only PCI. Baseline characteristics were comparable between groups. In the DCB-based group, 65.1% were treated with DCB-only. The primary endpoint was 2-year major bleeding, and the secondary endpoint was major adverse cardiovascular events (MACE).
At 2 years, major bleeding was lower in the DCB-based group compared with DES-only PCI (2.3% vs. 5.9%; HR 0.41; 95% CI 0.19-0.92; P = 0.030). MACE incidence was similar between groups (10.7% vs. 13.0%; HR 0.77; 95% CI 0.50-1.18; P = 0.230). Five target lesion thromboses occurred in the DES-only group and none in the DCB-based group. Multivariable analysis confirmed DCB-based PCI was independently associated with lower major bleeding risk.

Among patients with CKD, DCB-based PCI was associated with reduced 2-year major bleeding without significant differences in MACE. These findings suggest DCB-based PCI may be a treatment option in patients with CKD in whom bleeding risk is a clinical concern.