Drug-Coated Balloon vs. Drug-Eluting Stent for Clinical Outcomes in Patients With Large Coronary Artery Disease

Prior treatment

• Lesion-related:
  • Small vessel disease, defined as \<3.0 mm of reference vessel diameter by visual estimation
  • In-stent restenosis lesions for study lesions
  • Patient will be excluded if meet any of the following angiographic exclusion criteria after lesion preparation:
  • (i) Flow limiting dissection with TIMI flow \< III (ii) Residual diameter stenosis \>30%
  • \* The case of persistent ischemic symptoms/signs is up to the operator's decision
  • Lesions which are untreatable with PCI or other interventional techniques and coronary artery spasm in the absence of a significant stenosis
  • Left main disease or aorta-ostial lesion requiring revascularization
  • Severely calcified or tortuous vessels precluding DCB or DES application
  • Prior Coronary Artery Bypass Graft (CABG)

Lab values

• Patient-related:
  • Intolerance or allergy to Paclitaxel and/or the delivery matrix (main ingredient: Iopromide)
  • Severe allergy to contrast media
  • Recent STEMI (ongoing or \< 48 hours after primary PCI and/or has sign of thrombus in lesion(s) to treat)
  • NSTEMI hemodynamically unstable
  • Known left ventricular ejection fraction of \<30%
  • Inability to take dual antiplatelet therapy or anticoagulation, or single antiplatelet therapy for at least six months
  • Non-cardiac co-morbid conditions that may result in protocol non-compliance and inability of patient to complete the study (per the site investigator's medical judgment)
  • Patient with concomitant medical illnesses that require cytostatic, radiation therapy or renal replacement therapy
  • Patient who is currently/ planning to participate in another clinical trial when such participation could confound the treatment or outcomes of this study, except for observational registry
  • Pregnancy or lactation
  • Patient under administrative or judicial custody

• Patient-related:
  • Patient must be ≥ 18 years of age
  • Patient is able to verbally confirm understanding of the study aim, risks, benefits, and treatment alternatives of receiving DCB or DES and he/she or his/her legally authorized representative provides written informed consent prior to any study-related procedure
  • (i) Clinical evidence of angina, and/or (ii) an abnormal functional study demonstrating myocardial ischemia due to the target lesion(s), or (iii) acute coronary syndrome \[unstable angina or non-ST-elevation myocardial infarction (NSTEMI) or uneventful STEMI (≥ 48 hours after primary PCI and no sign of thrombus in lesion(s) to treat)\]
  • Patient with lesions suitable for PCI with a DCB (and/or DES) according to the Instructions for Use
  • Patient is able to comply with the study protocol and agrees to undergo the clinical follow-up of 30 days, 6 months, 12 months, 24 months, and 36 months
• Lesion-related:
  • Presence of significant de novo large vessel coronary artery disease (reference vessel diameter ≥3.0 mm by visual estimation) with either ≥ 70% diameter stenosis or intermediate ≥ 50% to \<70% diameter stenosis with abnormal functional test or symptom of ischemia
  • Successful lesion preparation. For randomisation, the lesion must satisfy the following criteria after optimal balloon angioplasty: no flow-limiting dissection (TIMI=3), and residual stenosis is ≤ 30%
• Multivessel disease with two or more vessels showing diameter stenosis of 50% or more is not an exclusion as long as it fulfills all study's eligibility criteria.
• In diffuse lesion, inclusion is possible if the proximal reference vessel diameter is 3.0 mm or more.