{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:07:06Z","timestamp":1786122426199,"version":"build-2736575974"},"reference-count":25,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Whether the comparative effectiveness of a drug-coated balloon (DCB)-based versus drug-eluting stent (DES)-only percutaneous coronary intervention (PCI) strategy differs between stable angina (SA) and acute coronary syndrome (ACS) remains uncertain. Methods: In this observational, registry-based study, we analyzed 11,522 patients (4490 with SA and 7032 with ACS) from two multicenter registry sources who had undergone PCI in routine clinical practice; the treatment strategy was not assigned by a study protocol. Within each presentation, the DCB-based and DES-only strategies were compared using propensity-score overlap weighting. Complementary within-strategy analyses compared SA with ACS. The primary outcome was the 3-year rate of major adverse cardiac and cerebrovascular events (MACCE). Results: In both presentations, a DCB-based strategy was associated with a lower 3-year risk of MACCE than a DES-only strategy, with a stronger association in SA (overlap-weighted hazard ratio [HR], 0.33; 95% confidence interval [CI], 0.22\u20130.49) than in ACS (HR, 0.73; 95% CI, 0.59\u20130.91; p-for-interaction &lt; 0.001). Within-strategy analyses localized this effect modification to the DCB-based group: SA was associated with a lower risk of MACCE than ACS (HR, 0.47; 95% CI, 0.31\u20130.69) in the DCB-based group, whereas this gradient was absent in the DES-only group. The incidence of major bleeding was lower with the DCB-based strategy in both presentations. Conclusions: A DCB-based PCI strategy was associated with lower 3-year event rates than a DES-only strategy in both SA and ACS, with the strongest relative association in SA. These observational findings are hypothesis-generating and warrant confirmation in randomized trials.<\/jats:p>","DOI":"10.3390\/jcm15166140","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T10:12:01Z","timestamp":1786097521000},"page":"6140","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Drug-Coated Balloon-Based Versus Drug-Eluting Stent-Only Strategy in Stable Angina and Acute Coronary Syndrome: A Propensity-Score Overlap-Weighted Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9669-3598","authenticated-orcid":false,"given":"Yong Hoon","family":"Kim","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Chuncheon 24341, Republic of Korea"},{"name":"Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Chuncheon 24289, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9990-6843","authenticated-orcid":false,"given":"Ae-Young","family":"Her","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Chuncheon 24341, Republic of Korea"},{"name":"Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Chuncheon 24289, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7735-1763","authenticated-orcid":false,"given":"Sunwon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5187-8310","authenticated-orcid":false,"given":"Dong Oh","family":"Kang","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7403-3778","authenticated-orcid":false,"given":"Chang-Bae","family":"Sohn","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ulsan Medical Center, Ulsan 44686, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9169-6968","authenticated-orcid":false,"given":"Eun-Seok","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1852","DOI":"10.1161\/CIRCRESAHA.114.302721","article-title":"Mechanisms of plaque formation and rupture","volume":"114","author":"Bentzon","year":"2014","journal-title":"Circ. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1001\/jamacardio.2024.4244","article-title":"Drug-coated balloons for the treatment of coronary artery disease: A review","volume":"10","author":"Camaj","year":"2025","journal-title":"JAMA Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1016\/S0140-6736(18)31719-7","article-title":"Drug-coated balloons for small coronary artery disease (BASKET-SMALL 2): An open-label randomised non-inferiority trial","volume":"392","author":"Jeger","year":"2018","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1007\/s00392-020-01734-6","article-title":"Long-term safety of paclitaxel drug-coated balloon-only angioplasty for de novo coronary artery disease: The SPARTAN DCB study","volume":"110","author":"Merinopoulos","year":"2021","journal-title":"Clin. Res. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e038071","DOI":"10.1161\/JAHA.124.038071","article-title":"Successful or uncomplicated use of drug-coated balloon versus drug-eluting stent strategies for de novo culprit lesions in acute coronary syndromes: Insights from a nationwide registry in Japan","volume":"14","author":"Takahashi","year":"2025","journal-title":"J. Am. Heart Assoc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1527","DOI":"10.4244\/EIJ-D-19-00723","article-title":"Bare metal or drug-eluting stent versus drug-coated balloon in non-ST-elevation myocardial infarction: The randomised PEPCAD NSTEMI trial","volume":"15","author":"Scheller","year":"2020","journal-title":"EuroIntervention"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e011325","DOI":"10.1161\/CIRCINTERVENTIONS.121.011325","article-title":"Safety and efficacy of drug-coated balloons versus drug-eluting stents in acute coronary syndromes: A prespecified analysis of BASKET-SMALL 2","volume":"15","author":"Mangner","year":"2022","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.jcin.2022.10.049","article-title":"Clinical impact of drug-coated balloon-based percutaneous coronary intervention in patients with multivessel coronary artery disease","volume":"16","author":"Shin","year":"2023","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"413","DOI":"10.3349\/ymj.2022.63.5.413","article-title":"Platelet function and genotype after DES implantation in East Asian patients: Rationale and characteristics of the PTRG-DES consortium","volume":"63","author":"Her","year":"2022","journal-title":"Yonsei Med. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1016\/j.jcin.2020.02.043","article-title":"Drug-coated balloons for coronary artery disease: Third report of the International DCB Consensus Group","volume":"13","author":"Jeger","year":"2020","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1016\/j.jacasi.2025.02.017","article-title":"Drug-coated balloons-based intervention for coronary artery disease: The second report of Asia-Pacific Consensus Group","volume":"5","author":"Her","year":"2025","journal-title":"JACC Asia"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2635","DOI":"10.1161\/CIRCULATIONAHA.117.029289","article-title":"Standardized end point definitions for coronary intervention trials: The Academic Research Consortium-2 consensus document","volume":"137","author":"McFadden","year":"2018","journal-title":"Circulation"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2231","DOI":"10.1016\/j.jacc.2018.08.1038","article-title":"Executive Group on behalf of the Joint European Society of Cardiology (ESC); American College of Cardiology (ACC); American Heart Association (AHA); et al. Fourth universal definition of myocardial infarction (2018)","volume":"72","author":"Thygesen","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2064","DOI":"10.1161\/STR.0b013e318296aeca","article-title":"An updated definition of stroke for the 21st century: A statement for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"44","author":"Sacco","year":"2013","journal-title":"Stroke"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2736","DOI":"10.1161\/CIRCULATIONAHA.110.009449","article-title":"Standardized bleeding definitions for cardiovascular clinical trials: A consensus report from the Bleeding Academic Research Consortium","volume":"123","author":"Mehran","year":"2011","journal-title":"Circulation"},{"key":"ref_16","first-page":"250","article-title":"Addressing extreme propensity scores via the overlap weights","volume":"188","author":"Li","year":"2019","journal-title":"Am. J. Epidemiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1093\/aje\/kwj149","article-title":"Variable selection for propensity score models","volume":"163","author":"Brookhart","year":"2006","journal-title":"Am. J. Epidemiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1080\/00273171.2011.568786","article-title":"An introduction to propensity score methods for reducing the effects of confounding in observational studies","volume":"46","author":"Austin","year":"2011","journal-title":"Multivar. Behav. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1161\/CIRCOUTCOMES.113.000359","article-title":"Propensity score methods for confounding control in nonexperimental research","volume":"6","author":"Brookhart","year":"2013","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"268","DOI":"10.7326\/M16-2607","article-title":"Sensitivity analysis in observational research: Introducing the E-value","volume":"167","author":"VanderWeele","year":"2017","journal-title":"Ann. Intern. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1016\/S0140-6736(24)01594-0","article-title":"Drug-coated balloon angioplasty with rescue stenting versus intended stenting for the treatment of patients with de novo coronary artery lesions (REC-CAGEFREE I): An open-label, randomised, non-inferiority trial","volume":"404","author":"Gao","year":"2024","journal-title":"Lancet"},{"key":"ref_22","first-page":"1796","article-title":"Drug-coated balloons in coronary artery disease: Engineering, pharmacology, and the mechanisms behind angiographic outcomes","volume":"107","author":"Marchetta","year":"2026","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.1161\/ATVBAHA.119.312705","article-title":"Atherosclerosis in chronic kidney disease: More, less, or just different?","volume":"39","author":"Valdivielso","year":"2019","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e002447","DOI":"10.1161\/CIRCINTERVENTIONS.114.002447","article-title":"Etiology, frequency, and clinical outcomes of myocardial infarction after successful drug-eluting stent implantation: Two-year follow-up from the ADAPT-DES study","volume":"8","author":"Dohi","year":"2015","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1056\/NEJMoa2512686","article-title":"Beta-blockers after myocardial infarction with normal ejection fraction","volume":"394","author":"Kristensen","year":"2026","journal-title":"N. Engl. J. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6140\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T10:21:19Z","timestamp":1786098079000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6140"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,7]]},"references-count":25,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15166140"],"URL":"https:\/\/doi.org\/10.3390\/jcm15166140","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,7]]}}}