{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T05:04:22Z","timestamp":1789967062734,"version":"4.0.1"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      This meta-analysis aimed to compare the efficacy and safety of drug-coated balloons (DCB) vs. drug-eluting stents (DES) in patients with\n                      <jats:italic>de novo<\/jats:italic>\n                      small coronary artery disease.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We systematically searched PubMed, Embase, Cochrane Library, and Web of Science from inception to March 18, 2024, for randomized controlled trials comparing DCB with DES in small-vessel coronary disease (reference vessel diameter \u22642.75\u2005mm or \u22642.5\u2005mm). Primary outcomes included nonfatal myocardial infarction, cardiac death, all-cause death, target lesion revascularization (TLR), and target-vessel revascularization (TVR). Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using fixed- or random-effects models depending on heterogeneity. Certainty of evidence was assessed using the GRADE framework. The protocol was registered with PROSPERO.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Six unique RCT cohorts (eight publications) comprising 1,849 patients were included. No significant differences were observed between DCB and DES for nonfatal myocardial infarction (OR\u2009=\u20090.87, 95% CI: 0.55\u20131.39;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200939%), cardiac death (OR\u2009=\u20091.38, 95% CI: 0.66\u20132.88;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%; four trials), all-cause death (OR\u2009=\u20091.00, 95% CI: 0.59\u20131.69;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%), TLR (OR\u2009=\u20091.03, 95% CI: 0.65\u20131.64;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200925%), or TVR (OR\u2009=\u20090.76, 95% CI: 0.47\u20131.23; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200934%). Subgroup analysis suggested a potential TLR benefit in very small vessels (\u22642.25\u2005mm), but this finding was exploratory with no significant interaction across subgroups. All outcomes were rated as moderate certainty, except TVR (low to moderate), with downgrading primarily due to imprecision and open-label design limitations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Current randomized evidence indicates that DCB provides comparable clinical outcomes to DES in patients with\n                      <jats:italic>de novo<\/jats:italic>\n                      small coronary artery disease. However, the limited number of trials and insufficient power for subgroup analyses underscore the need for larger, well-powered randomized studies to define the optimal strategy, particularly in specific patient and vessel subsets.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic Review Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/<\/jats:ext-link>\n                      , identifier CRD420261500541.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1906701","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T04:28:12Z","timestamp":1789964892000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating drug-coated balloon versus drug-eluting stent for the treatment of small coronary artery disease: a meta-analysis and systematic review"],"prefix":"10.3389","volume":"13","author":[{"given":"Yanjie","family":"Gao","sequence":"first","affiliation":[{"name":"Emergency Internal Medicine Department, The Affiliated Hospital of Inner Mongolia Medical University","place":["Hohhot, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Lian","sequence":"additional","affiliation":[{"name":"Emergency Internal Medicine Department, The Affiliated Hospital of Inner Mongolia Medical University","place":["Hohhot, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e15622","DOI":"10.1097\/MD.0000000000015622","article-title":"Drug-coated balloon versus drug-eluting stent in de novo small coronary vessel disease: a systematic review and meta-analysis","volume":"98","author":"Li","year":"2019","journal-title":"Medicine (Baltimore)"},{"key":"B2","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1016\/j.acvd.2013.06.056","article-title":"Safety and effectiveness of drug-eluting stents versus bare-metal stents in elderly patients with small coronary vessel disease","volume":"106","author":"Puymirat","year":"2013","journal-title":"Arch Cardiovasc Dis"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1016\/j.jacc.2019.12.046","article-title":"Drug-coated balloon for de novo coronary artery disease: JACC state-of-the-art review","volume":"75","author":"Yerasi","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1016\/j.jcin.2023.01.380","article-title":"Assessment of paclitaxel drug-coated balloon only angioplasty in STEMI","volume":"16","author":"Merinopoulos","year":"2023","journal-title":"JACC Cardiovasc Interv"},{"key":"B5","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1007\/s12928-023-00921-2","article-title":"Clinical expert consensus document on drug-coated balloon for coronary artery disease from the Japanese association of cardiovascular intervention and therapeutics","volume":"38","author":"Muramatsu","year":"2023","journal-title":"Cardiovasc Interv Ther"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1341","DOI":"10.1016\/j.jcin.2017.05.019","article-title":"Drug-coated balloon: \u201cscoring to win\u201d","volume":"10","author":"De La Torre Hernandez","year":"2017","journal-title":"JACC Cardiovasc Interv"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e7084","DOI":"10.1161\/CIRCINTERVENTIONS.118.007084","article-title":"Drug-coated balloon for long femoropopliteal lesions","volume":"11","author":"Banerjee","year":"2018","journal-title":"Circ Cardiovasc Interv"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1291","DOI":"10.1136\/hrt.2010.195057","article-title":"Paclitaxel-coated balloon versus drug-eluting stent during PCI of small coronary vessels, a prospective randomised clinical trial. 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