Predictors of Optimal Angiographic Lesion Outcomes in Drug-Coated Balloon Treatment for De Novo Coronary Artery Disease: Insights from a Prospective Study and Intravascular Ultrasound Subgroup Analysis

Predictors of Optimal Angiographic Lesion Outcomes in Drug-Coated Balloon Treatment for De Novo Coronary Artery Disease: Insights from a Prospective Study and Intravascular Ultrasound Subgroup Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Predictors of Optimal Angiographic Lesion Outcomes in Drug-Coated Balloon Treatment for De Novo Coronary Artery Disease: Insights from a Prospective Study and Intravascular Ultrasound Subgroup Analysis Dong Oh Kang, Jong-Seok Lee, Bitna Kim, Yong-Hyun Kim, Sang-Yup Lim, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5181772/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Mar, 2025 Read the published version in Scientific Reports → Version 1 posted 10 You are reading this latest preprint version Abstract Drug-coated balloon (DCB) treatment is an emerging strategy for de novo coronary artery disease (CAD), but procedural optimization remains uncertain. This study analyzed 317 patients who underwent DCB-based intervention for de novo CAD and angiographic follow-up: SR (successful, stent-like result: diameter stenosis <20% at follow-up angiography, n=84, 93 lesions) and Non-SR (n=224, 358 lesions) groups. Baseline clinical and lesion characteristics were similar, except that SR lesions had larger diameter. In SR lesions, specialty balloons were more frequently utilized (p=0.025), and maximal balloon diameter and balloon-to-artery ratio were significantly greater compared to Non-SR lesions (p<0.001 and p=0.008). At a median 8-month follow-up, SR lesions exhibited larger minimal luminal diameter (MLD) and lower late lumen loss, with negative values indicating positive vessel remodeling. In multivariate analysis, post-DCB MLD (odds ratio 1.17 per 0.1mm increase, p<0.001) and balloon-to-artery ratio (odds ratio 1.43 per 0.1 increase, p=0.002) were independent predictors for successful angiographic outcomes with thresholds of 1.95 mm for post-DCB MLD and 1.13 for balloon-to-artery ratio. In 47 patients, IVUS guidance resulted in balloon-to-artery ratio of 1.23 as calculated by QCA. The study demonstrated the importance of achieving maximal post-DCB MLD through aggressive lesion predilation, underscoring the need for refining procedural strategies. Health sciences/Cardiology/Cardiac device therapy Health sciences/Cardiology/Interventional cardiology coronary artery disease drug-coated balloon lesion predilation oversized ballooning balloon-to-artery ratio Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION Drug-coated balloon (DCB) treatment represents an emerging therapeutic strategy for the management of obstructive coronary artery disease (CAD). 1 Its established safety and efficacy profiles in addressing conditions such as in-stent restenosis (ISR) 2 have spurred ongoing investigations aimed at elucidating its applicability across a broader spectrum of CAD including de novo native coronary lesions. 1–3 In a meta-analysis, the use of DCBs was shown to have an efficacy profile comparable to drug-eluting stents (DES) in the treatment of de novo lesions, resulting in similar outcomes across clinical endpoints, including target lesion or vessel revascularization, myocardial infarction, and mortality. 3 However, DCB treatment was associated with poorer angiographic surrogate endpoint such as a significantly higher percentage diameter stenosis (%DS) and smaller minimal luminal diameter (MLD) at angiographic follow-up. 3 Optimal lesion preparation is increasingly recognized as a pivotal step to enhance the efficacy of DCB treatment. 1,4 This approach is instrumental for ensuring effective plaque modification and achieving sufficient luminal gain to restore and accommodate physiologic coronary blood flow. Additionally, it facilitates drug transfer to a broader contact area, thereby enhancing the therapeutic benefits of DCB treatment with the concept of “leaving nothing behind”. In previous study exploring key procedural factors in treating ISR lesions using DCBs, the predictors of target lesion failure (TLF) included residual DS ≥ 20%, DCB-to-stent ratio ≤ 0.91, and inflation time ≤ 60 seconds, emphasizing the importance of procedural optimization. 5 However, for de novo coronary lesions, there has been a lack of studies exploring specific procedure-related factors predictive of successful DCB outcomes. In this study, we aimed to evaluate the prognostic value of various procedure-related factors on angiographic outcomes in patients undergoing DCB treatment for de novo lesions. RESULTS Study population This study was based on the all-comers prospective registry that was conducted at Korea University Ansan Hospital from July 2019 to February 2023 (Impact of Drug-Coated Balloon Treatment in De Novo Coronary Lesion; NCT04619277). A total of 308 patients who underwent angiographic follow-up were analyzed. Exclusions were made for individuals with ISR, restenosis after DCB treatment (n = 2), heavily calcified lesions treated by rotational atherectomy (n = 1), coronary lesions in grafted vessels or transplanted hearts (n = 1), and coronary lesions unsuitable for QCA measurement, such as chronic total occlusion lesions (n = 5) (Fig. 1 ). This study specifically focused on identifying crucial procedural steps to achieve favorable angiographic results comparable to those of DESs. Given that earlier studies reported a mean %DS of approximately 20% after paclitaxel-based DES implantation ( Supplementary Table 1 and Supplementary Fig. 1 ), 6,7 the study population was categorized into two groups based on follow-up angiographic findings: the SR (successful, stent-like result, %DS < 20%, n = 224, 358 lesions) group and the Non-SR group (%DS ≥ 20%, n = 224, 358 lesions) (Fig. 1 ). During a median follow-up of 24.0 months (interquartile range [IQR]: 13.8–34.6), the overall incidence of TLF was 5.2% (16/308) in the study population. Baseline Clinical Characteristics The baseline clinical characteristics of the study population are shown in Table 1 . In overall study population treated with DCBs, 78.0% (240/308) presented with acute coronary syndrome, with 26.3% (81/308) experiencing acute MI. Chronic kidney disease was present in 13.3% (41/308) of the patients, while 28.4% (87/308) had left ventricular dysfunction. Baseline clinical characteristics, including demographics, comorbidities, cardiac risk factors, laboratory findings, and angiographic disease extent, were comparable between the SR and Non-SR groups. Table 1 Baseline characteristics of the study population Overall population (n = 308) SR group (DS < 20% at FU) (n = 84) Non-SR group (DS ≥ 20% at FU) (n = 224) P-value Demographics Age (years) 61.8 ± 10.5 61.7 ± 10.9 61.8 ± 10.4 0.985 Sex (male) 235 (76.3) 63 (75.0) 172 (76.8) 0.743 BMI (kg/m 2 ) 25.0 ± 3.0 25.0 ± 03.5 25.0 ± 2.8 0.860 SBP (mmHg) 137.6 ± 22.2 140.2 ± 22.1 136.6 ± 22.2 0.241 DBP (mmHg) 79.5 ± 15.2 80.5 ± 14.6 79.1 ± 15.5 0.528 HR (per min) 80.1 ± 15.9 79.5 ± 13.2 80.3 ± 16.8 0.716 Medical comorbidities Hypertension (%) 222 (72.1) 58 (69.0) 164 (73.2) 0.468 Diabetes mellitus (%) 132 (42.9) 32 (38.1) 100 (44.6) 0.301 Dyslipidemia (%) 202 (65.6) 50 (59.5) 152 (67.9) 0.170 Chronic kidney disease (%) 41 (13.3) 10 (11.9) 31 (13.8) 0.656 End-stage renal disease (%) 22 (7.1) 5 (6.0) 17 (7.6) 0.619 Current smoker (%) 75 (24.5) 19 (22.6) 56 (25.2) 0.628 Prior MI (%) 46 (15.0) 12 (14.3) 34 (15.3) 0.822 Prior PCI (%) 68 (22.1) 19 (22.6) 49 (21.9) 0.888 Prior CVA (%) 19 (6.2) 2 (2.4) 17 (7.6) 0.094 Acute coronary syndrome (%) 240 (77.9) 70 (83.3) 170 (75.9) 0.161 Acute MI (%) 81 (26.3) 24 (28.6) 57 (25.4) 0.579 LV dysfunction (EF < 50) (%) 87 (28.4) 21 (25.0) 66 (29.7) 0.413 LVEF (%) 57.5 (47.0–65.0) 60.0 (49.3–65.0) 57.0 (45.4–63.8) 0.060 Laboratory findings Total cholesterol (mg/dL) 143.0 (116.0–186.5) 151.0 (118.3–186.5) 141.0 (115.0–186.5) 0.807 Triglyceride (mg/dL) 126.0 (116.0–186.5) 118.5 (80.0–179.5) 126.0 (89.0–173.5) 0.836 HDL cholesterol (mg/dL) 43.0 (36.0–50.0) 44.0 (36.0–53.0) 43.0 (36.0–50.0) 0.471 LDL cholesterol (mg/dL) 83.0 (56.5–119.0) 84.0 (57.5–118.8) 80.0 (56.0–119.5) 0.890 Creatinine (mg/dL) 0.91 (0.77–1.05) 0.92 (0.81–1.05) 0.91 (0.77–1.05) 0.658 HbA1c (%) 6.10 (5.70–6.98) 6.0 (5.60–6.90) 6.20 (5.70–7.08) 0.238 hs-CRP (mg/L) 0.12 (0.05–0.29) 0.13 (0.06–0.23) 0.11 (0.05–0.31) 0.372 Angiographic disease extent One-vessel disease (%) 107 (34.7) 35 (41.7) 72 (32.1) 0.118 Two-vessel disease (%) 118 (38.3) 28 (33.3) 90 (40.2) 0.271 Three-vessel disease (%) 83 (26.3) 21 (25.0) 62 (27.7) 0.637 Data are expressed as frequency (percent), mean ± standard deviation, or median (interquartile range). Abbreviations: BMI = body mass index; DBP = diastolic blood pressure; CVA = cerebrovascular accident; FU = follow-up; HbA1c = glycated hemoglobin; hs-CRP = high sensitivity C-reactive protein; HDL = high-density lipoprotein; HR = heart rate; LDL = low-density lipoprotein; LV = left ventricular; LVEF = left ventricular ejection fraction; MI = myocardial infarction; SR = optimal result; PCI = percutaneous coronary intervention; SBP = systolic blood pressure Lesion and Procedural Characteristics In terms of lesion characteristics (Table 2 ), 74.3% (335/451) of the target lesions were located in the major epicardial arteries, and 74.7% (337/451) were classified as type B2 or C according to the American College of Cardiology/American Heart Association classification. Lesion location and complexity were similar between the two groups. Quantitatively, angiographic lesion characteristics were comparable, except for a larger RVD in the SR compared to the Non-SR group (2.66 ± 0.48 vs. 2.49 ± 0.47 mm; p = 0.001). Specialty balloons (scoring: 96.5% and non-compliant balloon: 3.5%) were more frequently used for lesion preparation in the SR group (54.8% vs. 41.9%; p = 0.025). Regarding the DCB profile, the SR group displayed significantly larger values for maximal balloon diameter (3.19 ± 0.52 vs. 2.90 ± 0.48 mm; p < 0.001) and B-A ratio (1.129 ± 0.107 vs. 1.095 ± 0.109; p = 0.008) compared to the Non-SR group. The occurrence of angiographically significant coronary artery dissection did not show any significant difference between the groups. Post-DCB QCA measurements of RVD, MLD, and acute luminal gain showed significantly larger values in the SR group. Table 2 Baseline lesion characteristics and quantitative angiographic parameter pre- and post-procedure, and at angiographic follow-up All lesions (n = 451) SR lesion (n = 93) Non-SR lesion (n = 358) P-value Target lesion location 0.968 LAD / Diagonal (%) 142 / 47 (41.9%) 32 / 4 (38.7) 110/43 (42.7) LCX / OM (%) 114 / 25 (30.8%) 29 / 4 (35.5) 85/21 (29.6) RCA / PDA or PLV (%) 99 / 30 (23.7) 20 / 2 (23.7) 79 / 28 (23.7) Ramus intermedius (%) 16 (3.5%) 2 (2.2) 14 (3.9) ACC/AHA lesion type 0.416 type A (%) 30 (6.7) 7 (7.5) 23 (6.4) type B1 (%) 84 (18.6) 16 (17.2) 68 (19.0) type B2 (%) 162 (35.9) 40 (43.0) 122 (34.1) type C (%) 175 (38.8) 30 (32.3) 145 (40.5) type B2 or C (%) 337 (74.7) 70 (75.3) 267 (74.6) 0.892 QCA (pre-procedure) lesion length (mm) 19.81 ± 6.60 18.88 ± 6.70 20.05 ± 6.56 0.129 lesion RVD (mm) 2.53 ± 0.47 2.66 ± 0.48 2.49 ± 0.47 0.001 lesion MLD (mm) 0.75 ± 0.37 0.77 ± 0.40 0.75 ± 0.36 0.583 lesion DS (%) 70.20 ± 13.59 71.11 ± 14.40 69.96 ± 13.39 0.466 DCB treatment procedure specialty balloon used * (%) 201 (44.6) 51 (54.8) 150 (41.9) 0.025 max balloon diameter (mm) 2.96 ± 0.50 3.19 ± 0.52 2.90 ± 0.48 < 0.001 balloon-to-artery ratio 1.102 ± 0.109 1.129 ± 0.107 1.095 ± 0.109 0.008 dissection (%) 157 (34.8) 26 (28.0) 131 (36.6) 0.119 QCA (post-DCB treatment) lesion RVD (mm) 2.70 ± 0.46 2.84 ± 0.47 2.66 ± 0.45 0.001 lesion MLD (mm) 1.89 ± 0.46 2.14 ± 0.47 1.83 ± 0.44 < 0.001 lesion DS (%) 29.99 ± 10.71 24.70 ± 10.06 31.36 ± 10.46 < 0.001 acute luminal gain (mm) 1.14 ± 0.50 1.37 ± 0.50 1.08 ± 0.49 < 0.001 QCA (Follow-up angiogram) lesion RVD (mm) 2.63 ± 0.47 2.77 ± 0.45 2.60 ± 0.47 0.002 lesion MLD (mm) 1.85 ± 0.53 2.37 ± 0.38 1.72 ± 0.48 < 0.001 lesion DS (%) 30.50 ± 13.89 14.68 ± 3.87 34.61 ± 12.54 < 0.001 late lumen loss (mm) 0.04 ± 0.41 -0.21 ± 0.32 0.11 ± 0.41 < 0.001 Net lumen gain 1.10 ± 0.56 1.60 ± 0.48 0.97 ± 0.50 < 0.001 Binary restenosis 28 (6.2%) 0 (0.0%) 28 (7.9%) 0.003 Data are expressed as frequency (percent) or mean ± standard deviation. * Specialty balloons includes both scoring (96.5%) and non-compliant (3.5%) balloons. ACC/AHA = American College of Cardiology/American Heart Association; DS = diameter stenosis; LAD = left anterior descending; LCX = left circumflex; MLD = minimal lumen diameter; OM = obtuse marginal; SR = optimal result; PDA = posterior descending artery; PLV = posterior left ventricular; QCA = quantitative coronary angiography; RCA = right coronary artery; RVD = reference vessel diameter Angiographic Follow-up: Vessel Remodeling and MLD Changes The median duration from the index PCI to angiographic follow-up was 8.0 months (IQR: 6.0–11.0). Follow-up QCA measurements of RVD and MLD showed significantly larger values in the SR than in the Non-SR group. In particular, the degree of LLL showed significant difference between the groups (-0.21 ± 0.32 vs. 0.11 ± 0.41 mm; p < 0.001), with the SR group exhibiting a negative mean LLL value, indicative of positive vessel remodeling after DCB treatment. The distribution curves of MLD changes are shown in Fig. 2 . Both the SR and Non-SR groups exhibited a significant difference between post-DCB and follow-up MLD measurements in pairwise comparisons. Specifically, MLD measurements significantly increased in the SR group (post-DCB vs. follow-up: 2.14 ± 0.47 vs, 2.37 ± 0.38 mm, p < 0.001) and decreased in the Non-SR group (post-DCB vs. follow-up: 1.83 ± 0.44 vs. 1.72 ± 0.48 mm, p < 0.001). The percentage increase in MLD was 13.41 ± 18.51% in the SR group and − 4.20 ± 23.32% in the non-SR group (p < 0.001). Predictors of Successful Angiographic Outcomes: Multivariate Analysis and ROC Curves In multivariate logistic regression analysis (Table 3 ), we systematically examined a wide range of peri-procedural factors including lesion characteristics, procedural parameters, and angiographic QCA measurements, for predicting optimal angiographic outcome. Following forward conditional analysis, post-DCB MLD (per 0.1 mm increase; odds ratio [SR] 1.168, 95% confidence interval [CI] 1.141–1.198; p < 0.001) and B-A ratio (per 0.1 increase; SR 1.432, 95% CI 1.318–1.547; p = 0.002) remained as robust independent predictors for successful angiographic outcomes following DCB treatment. In ROC curve analyses, the optimal thresholds for predicting successful DCB outcome based on the Yuden index was determined as 1.945 mm for post-DCB MLD (area under curve [AUC] 0.684) and 1.127 for B-A ratio (AUC 0.578) (Fig. 3 ). Combining these factors increased the overall predictive power to an AUC of 0.703. Table 3 Univariate and multivariate logistic regression analysis exploring procedural factors associated with optimal angiographic outcome Univariate analysis Multivariate analysis* SR (95% CI) P-value SR (95% CI) P-value Lesion location (LAD, LCX, RCA, and RI) 0.260 (0.143–0.376) < 0.001 ACC/AHA lesion type (B2C) 0.037 (0.768–1.307) 0.892 Specialty balloon used 1.684 (1.450–1.918) 0.026 Occurrence of angiographic dissection 0.672 (0.417–0.928) 0.121 Maximum balloon diameter (per 1.0 mm increase) 3.014 (2.784–3.244) < 0.001 B-A ratio (per 0.1 increase) 1.323 (1.216–1.430) < 0.001 1.432 (1.318–1.547) 0.002 Pre-DCB lesion length (per 1.0 mm increase) 0.973 (0.955–0.991) 0.129 Pre-DCB RVD (per 0.1 mm increase) 1.078 (1.054–1.102) 0.002 Pre-DCB MLD (per 0.1 mm increase) 1.018 (0.986–1.049) 0.582 Pre-DCB %DS (per 1.0% increase) 1.001 (1.000–1.001) 0.465 Post-DCB RVD (per 0.1 mm increase) 1.082 (1.057–1.107) 0.001 Post-DCB MLD (per 0.1 mm increase) 1.158 (1.131–1.184) < 0.001 1.168 (1.141–1.195) < 0.001 Post-DCB %DS (per 1.0% increase) 0.994 (0.992–0.995) < 0.001 Acute luminal gain (per 0.1 mm increase) 1.116 (1.093–1.139) < 0.001 * The variables included in the multivariate logistic regression analysis, using the forward conditional method, are as follows: lesion length, RVD, MLD and %DS before and after DCB treatment, acute luminal gain, max balloon diameter, B-A ratio, use of specialty balloon, occurrence of angiographic dissection, target lesion location, and ACC/AHA lesion classification type. Abbreviations: ACC/AHA = American College of Cardiology/American Heart Association; B-A = balloon-to-artery; CI = confidence interval; DCB = drug-coated balloon; DS = diameter stenosis; LAD = left anterior descending; LCX = left circumflex; MLD = minimal luminal diameter; SR = odds ratio; RCA right coronary artery; RI = ramus intermedius; RVD = reference vessel diameter Impact of IVUS Guidance on Vessel Measurements and Balloon Sizing Our study included a subgroup of 47 patients who received IVUS-guided DCB treatment for a total of 56 de novo lesions. We compared IVUS measurements and the balloon sizes utilized in these procedures with the RVD obtained from QCA (Table 4 ). Compared to QCA, IVUS revealed significantly larger vessel diameters based on the external elastic membrane diameter. The nominal diameter of pre-dilation balloons chosen by attending interventionists was 11% greater compared to QCA-derived RVD (B-A ratio: 1.11 ± 0.14). Ultimately, IVUS guidance resulted in a final B-A ratio of 1.23 ± 0.14, as calculated by QCA. Table 4 Comparison of QCA versus IVUS-based vessel sizing and final balloon diameter in patients treated by IVUS-guided DCB PCI Vessel size measurements All lesions (n = 56) Reference vessel diameter (RVD, interpolated by QCA) (mm) 2.93 ± 0.55 Distal reference lumen diameter (by IVUS) (mm) 3.02 ± 0.59 Distal reference EEM diameter (by IVUS) (mm) 3.84 ± 0.80 * Proximal reference lumen diameter (by IVUS) (mm) 3.52 ± 0.71 * Proximal reference EEM diameter (by IVUS) (mm) 4.58 ± 0.78 * Lumen diameter at the worst stenosis (by IVUS) (mm) 1.92 ± 0.24 * EEM diameter at the worst stenosis (by IVUS) (mm) 3.88 ± 0.64 * IVUS measurements vs. QCA Ratio (n = 56) Distal reference EEM diameter-to-RVD 1.32 ± 0.20 Distal reference lumen diameter-to-RVD 1.04 ± 0.14 Lesion EEM diameter (at the worst stenosis)-to-RVD 1.34 ± 0.21 IVUS-guided balloon size vs. QCA-RVD Ratio (n = 56) Pre-dilation balloon diameter † (at nominal pr.)-to-RVD 1.11 ± 0.14 Maximal balloon diameter ‡ -to-RVD 1.23 ± 0.14 * Indicates statistically significant difference compared to QCA-derived RVD (p < 0.05). † Indicates the size of the balloon chosen by the attending interventionist to pre-dilate the target lesion based on IVUS assessment. ‡ Maximal balloon diameter refers to the greatest diameter of either the pre-dilation balloon or the DCB, as actually inflated during the procedure. Abbreviations: DCB = drug-coated balloon; EEM = external elastic membrane; IVUS = intravascular ultrasound; PCI = percutaneous coronary intervention; QCA = quantitative coronary angiography; RVD = reference vessel diameter DICUSSION In this all-comer prospective study, we investigated the prognostic significance of various procedural characteristics on angiographic outcomes of DCB treatment for de novo coronary lesions. The key findings of the present study were as follows: First, notable disparities were observed in procedural characteristics between the lesions demonstrating successful, stent-like DCB results (SR) at angiographic follow-up and those not (Non-SR), particularly with the use of balloons with larger B-A ratio identified as an independent predictor of the success. Second, the significance of this distinct procedural step was corroborated by an improved immediate post-DCB angiographic outcomes, with a greater acute luminal gain and a larger MLD. Finally, these differences ultimately translated into a more favorable follow-up angiographic outcome in the SR group, characterized by a larger final MLD and positive vessel remodeling (Fig. 4 ). Current expert consensus documents commonly recommend a B-A ratio of approximately 0.8 to 1.0 for DCB angioplasty. 1,4 This recommended range considered to balance adequate lesion expansion and drug delivery against the potential risks of vessel injury. However, these recommendations are largely based on expert experience and consensus opinion, rather than robust clinical data. 1,4 Moreover, these guidelines do not provide detailed guidance on the measurement methods for determining RVD, such as whether visual assessment or QCA should be used, or whether to consider the distal, proximal, or mean RVD. Historically, in the pre-stent, percutaneous transluminal coronary angioplasty (PTCA) era, a higher B-A ratio of > 1.0 was often suggested. 8,9 Specifically, lesion preparation conducted by balloons with B-A ratio ranging from 0.9 to 1.3, as assessed by cine angiography, yielded optimal outcomes by minimizing dissections and residual stenosis. 10 The positive impact of oversized devices on procedural and clinical outcomes was also well documented for the DES therapy. 11 These insights from the historical studies are particularly relevant to our findings, emphasizing the importance of oversized ballooning in lesion preparation. Specifically, our data demonstrated that a 0.1 increase in the B-A ratio was associated with 43.2% increase in the odds of achieving favorable angiographic outcome at the median 8-month follow-up. Collectively, the current B-A ratio recommendations in DCB treatment for de novo CAD should be refined to establish optimal ranges and safety limits in light of this context. It is widely acknowledged that RVD is typically larger by intravascular imaging (IVI) than by angiography. 12 An earlier study by Stone GW et al. demonstrated that IVUS-guidance, compared to angiography-guided PTCA, resulted in balloon upsizing in 73% of participants, increasing B-A ratio from 1.12 ± 0.15 to 1.30 ± 0.17 (P < 0.0001). 8 This IVUS-guided PTCA led to a significant decrease in mean angiographic %DS and an increase in MLD, without significantly increasing peri-procedural complications. 8 The benefits of IVUS- versus angiography-guided PCI have also been well recognized in DES therapy. 13,14 In the ULTIMATE trial, IVUS-guided PCI led to more frequent post-dilation using larger balloons at higher pressures, resulting in a significantly greater MLD after DES implantation. 13,14 These specific procedural characteristics are suggested to translate into improved clinical outcomes. 13,14 Furthermore, a pooled analysis based on two randomized clinical trials (IVUS-XPL and ULTIMATE), stent oversizing of stent-to-vessel ratio of 1.1 to 1.3 was associated with better angiographic and clinical outcomes. 13–16 Given these insights, there is a growing need to explore how IVI guidance can influence DCB treatment in de novo CAD. Our analysis provides evidence that IVUS guidance led to a higher B-A ratio of 1.23 ± 0.14 through a more detailed assessment of target lesion anatomy. Further studies are warranted to determine more detailed, systematic balloon sizing strategy based on IVI and its impact on patient outcomes after DCB treatment. A previous study demonstrated that post-procedural MLD significantly predicted successful DCB treatment in de novo lesions. 17 Our study consistently demonstrated these findings, underscoring the importance of achieving sufficient luminal enlargement immediately after the procedure. Numerous studies on stent-based PCI have consistently shown a strong association between larger final stent dimensions and reduced rates of ISR, supporting the concept of “the larger, the better”. 14,16,18,19 In the context of DCB treatment, this relationship is particularly pertinent since DCBs, unlike stents, do not provide scaffolding to maintain vessel patency. Evidences from the PTCA era showed that repeated balloon overstretch using balloons with bigger B-A ratio alleviated early vessel recoil. 20 Furthermore, adequate luminal gain after PCI might facilitate the restoration of coronary laminar flow, leading to a favorable shear stress environment. Shear stress, the force exerted by blood flow on the vessel wall, plays a pivotal role in vascular biology and regulating vessel healing. 21 In the case of DCB treatment, enlarged lumen without residual metallic scaffold might promote a favorable hemodynamic microenvironment, potentially reducing the risks of abnormal vasomotion, thrombus formation, and neointimal proliferation/restenosis. 21,22 In our study, specialty balloons, predominantly scoring balloons, were more frequently used in SR group. However, they were not identified as an independent predictor in the multivariable logistic regression analysis. This observation should be interpreted with caution, as it does not necessarily imply that scoring balloons are ineffective. Rather, their impact may be overshadowed in the presence of stronger predictive factors such as B-A ratio or post-DCB MLD. Scoring balloons play a crucial role in controlled plaque modification, achieving sufficient luminal gain, and reducing the risk of serious vessel injury during the course of various endovascular intervention. 23,24 Their positive impact in DCB treatment was well demonstrated in treating ISR. 25,26 A recent study demonstrated that the utilization of a scoring balloon was associated with reduced risk of severe dissection and more favorable angiographic outcomes in treating de novo coronary lesions. 27 Accordingly, despite the larger maximum balloon diameter and B-A ratio observed in the SR group compared to the Non-SR group, there was no significant difference in the occurrence of coronary dissection in our study. These findings underscore the complexity of factors influencing DCB treatment outcomes and suggests that scoring balloons might still play a valuable, albeit not singularly decisive, role within the broader context of procedural strategy. Further research is needed to fully understand their role, especially in the treatment of complex lesions where controlled plaque modification and effective drug delivery are crucial. In our study, only paclitaxel-coated balloons were used, which limits the generalizability of our findings to limus-coated balloons. The AUC value obtained from the ROC analysis for the B-A ratio was relatively modest. Given the current recommendation of a B-A ratio between 0.8 and 1.0, attending interventionists tend to adhere closely this range, resulting in constrained variability in B-A ratio values. 1,4 Such limited variability or high correlation among procedural variables can compromise the discriminatory capacity of ROC model, thereby yielding a lower AUC. 28 Analyzing a more extensive dataset and incorporating diverse pre-dilation strategies in the future studies may contribute to achieving higher AUC values. Our study contributes significantly to the ongoing discussion about the optimal procedural steps and the appropriate application of DCB therapeutic strategies in de novo CAD. Given the historical precedents in the PTCA era and insights from stent therapy, specifically the concept of “the larger, the better”, our findings suggest the potential benefits of considering a higher B-A ratio to achieve maximal final MLD for successful DCB treatment. Future research, especially studies incorporating IVI, is essential to further optimize DCB treatment strategies and improve patient outcomes. METHODS Study Population This study was based on the all-comers prospective registry that was conducted at Korea University Ansan Hospital from July 2019 to February 2023 (Impact of Drug-Coated Balloon Treatment in De Novo Coronary Lesion; NCT04619277). This registry encompasses patients with significant CAD undergoing DCB-based percutaneous coronary intervention (PCI) with either DCB-only, or in combination with drug-eluting stent (DES) implantation for de novo lesions in native coronary arteries. Patients were excluded if they had a life expectancy of less than two years or declined to provide consent. Those with suboptimal DCB treatment procedures, characterized by delayed DCB delivery (exceeding 60 seconds), failure to deliver DCB at least by the second attempt, or insufficient inflation time (less than 30 seconds), were also ineligible. Patients underwent clinical follow-up after the index procedure through regularly scheduled outpatient clinic visits at 3- to 5- months interval or telephone interviews were conducted in cases where in-person visits were unavailable. This study analyzed a total of 317 patients underwent DCB-based PCI for de novo CAD and angiographic follow-up (Fig. 1 ). We further analyzed a subgroup of 47 patients who underwent intravascular ultrasound (IVUS)-guided DCB treatment in our cohort. This study was conducted in accordance with the Declaration of Helsinki (2013). Ethical approval was granted by the Ethics Committee of Korea University Ansan Hospital, with approval number [2019AS0162]. Written informed consent was obtained from all participants. DCB Treatment Procedure The DCB treatment procedure adhered to international and Asia-Pacific consensus recommendations, involving aggressive pre-dilation using a semi-compliant balloon, non-compliant balloon, or scoring balloon, as determined by the attending interventionist's discretion. 1,4 Our DCB registry meticulously records detailed information throughout the DCB treatment procedural steps, encompassing the types of pre-dilation balloon (semi-compliant, non-compliant, or scoring), the length and diameter of the balloons, and the maximum inflation pressure and diameter achieved during balloon inflation. In cases of type A to C dissections following pre-dilation, stenting was deferred unless flow limitation developed. Bail-out stenting was reserved for type D or more severe coronary dissections. The DCBs used were all paclitaxel-based devices (SeQuent Please or SeQuent Please NEO: B. Braun Melsungen AG, Melsungen, Germany) and inflated for a minimum of 30 seconds, mostly extending beyond 60 seconds, based on the attending interventionist's discretion. Definition of Successful Angiographic Results This study specifically focused on identifying crucial procedural steps to achieve favorable angiographic results comparable to those of DESs. Earlier studies that compared paclitaxel-based DES versus bare metal stent reported a mean %DS of 20.2%, ranging from 17.4 to 26.1%, in DES arm at angiographic follow-up ( Supplementary Table 1 and Supplementary Fig. 1 ). 6,7 In the present study, a successful, stent-like DCB treatment result was defined as DCB-treated lesions exhibiting %DS less than 20%, with no signs of residual dissection or aneurysmal deformation observed at angiographic follow-up. The study population was categorized into two groups based on follow-up angiographic findings: the SR (successful, stent-like result, %DS < 20%) group and the Non-SR group (Fig. 1 ). Coronary angiography and Quantitative Coronary Angiography (QCA) Analysis A minimum of two orthographic views were obtained to assess pre-procedural and post-procedural angiographic characteristics of the target lesions. Follow-up angiographies were recorded with projection angles similar to the final angiographies of the index procedure. The procedural efficacy and angiographic outcomes of DCB treatment were quantitatively assessed using QCA measurements. High-resolution angiograms, obtained using a standardized protocol, were digitally stored and analyzed with a dedicated QCA software system (e.g., CAAS II QCA, Pie Medical Imaging BV, Maastricht, The Netherlands). Two expert researchers (Jiho Hyun and Hye Young Heo), blinded to the study purpose, measured the QCA parameters before, immediately after the DCB treatment, and during the follow-up angiography. These measurements included lesion length, reference vessel diameter (RVD), MLD, %DS, and acute luminal gain, as per established recommendations. 29 Specifically, RVD was derived by an interpolated method, a broadly accepted and well-validated method by QCA. 29 Balloon-to-artery ratio (B-A ratio) was calculated as the maximal diameter of either pre-dilation balloon or DCB, whichever was larger, actually inflated during each procedure, divided by the target lesion RVD. Positive vessel remodeling was defined, according to QCA, as a target lesion exhibiting a negative value in LLL. Clinical follow-up and study endpoints Clinical endpoint was target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction (MI; excluding periprocedural MI and which not clearly linked to the target vessel), and clinically-driven target lesion revascularization at the longest follow-up available. Cardiac death was defined as any death that was not clearly of extracardiac origin, including MI. Clinically-driven target lesion revascularization was defined based on angiographic findings of %DS ≥ 50% during follow-up, accompanied by one or more of the following criteria: recurrent angina pectoris related to the target vessel, objective ischemic signs at rest or during exercise tests, abnormal fractional flow reserve results, or when %DS was ≥ 70%, even without ischemic signs or symptoms, in adherence to the Academic Research Consortium criteria. 30 Statistical Analysis Continuous variables are expressed as means ± standard deviations and dichotomous variables as counts and percentages. QCA measurements obtained before and immediately after DCB treatment, as well as those obtained at angiographic follow-up, were compared between the SR and Non-SR lesions. Continuous variables were compared using Student’s t-test or Mann–Whitney U-test, and categorical variables were compared using Pearson’s chi-square or Fisher’s exact test. Paired measurements were analyzed using the paired t-test to assess differences. Stepwise binary logistic regression analysis explored the potential association between procedure-related factors and angiographically successful DCB results. Covariates that showed statistical significance in the univariate analysis or deemed clinically important were included in the multivariate analysis using the forward conditional method. Receiver-operating characteristic (ROC) curves were generated for a specific procedural factor to determine the optimal threshold value for predicting favorable angiographic outcomes (the MedCalc software, version 22.021, Ostend, Belgium). Statistical analyses were performed using the SPSS software (version 20.0; IBM Corp., Armonk, NY, USA) and statistical significance was set at p-values of < 0.05. Declarations Acknowledgements We thank Hangseok Choi for statistical analysis; Ji Ho Hyun and Hye Young Heo for their assistance in measuring QCA; and Minjung Lee and Hye Young Heo for the administrative assistance in managing the research. Author Contributions D.O.K., E-S.S., and S.K. conceptualized the study. E-S.S. and S.K. designed the study protocol. D.O.K., S.K., A-Y.H. and E-S.S. wrote the original manuscript. S.K., J-S.L., Y-H.K., S-Y.L., S.H.K., J-C.A., and W-H.S. contributed to the data acquisition. D.O.K., S.K., B.K. and E-S.S. supervised analysis and interpretation. S.K., J-S.L., Y-H.K., S-Y.L., S.H.K., J-C.A., and W-H.S. contributed to data analyses and interpretation. All the authors have read and approved the final version of the manuscript. Data Availability Statement The corresponding author has full access to the study data, and anonymized data will be available upon reasonable request from a qualified researcher. Additional Information Competing Interests Statement The authors have nothing to disclose and declare no conflict of interest. Sources of Funding This study is funded by the Grants from National Research Foundation of Korea (NRF) funded by the Korean government [Grant number: NRF-2021R1F1A1061337 to S.K.][Grant number: RS-2023-00210960 to D.O.K.], Korea University Grant [Grant number K1923481, K2022971, K2111151, and K2211921 to S.K.; and K2225581 to D.O.K.]. Twitter Handle Achieving maximal post-DCB lumen gain through oversized ballooning was identified as the key predictor for favorable angiographic outcomes after DCB treatment for de novo coronary artery disease, underscoring the need for refining lesion predilation strategies.(#Drug-coated Balloons, , #De novo CAD, #Maximal post-DCB lumen gain, #Lesion predilation, and #Oversized ballooning) References Jeger, R. V. et al. Drug-Coated Balloons for Coronary Artery Disease: Third Report of the International DCB Consensus Group. JACC Cardiovasc Interv 13 , 1391-1402, doi:10.1016/j.jcin.2020.02.043 (2020). Neumann, F. J. et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. EuroIntervention 14 , 1435-1534, doi:10.4244/EIJY19M01_01 (2019). Sanz Sanchez, J. et al. Drug-Coated balloons vs drug-eluting stents for the treatment of small coronary artery disease: A meta-analysis of randomized trials. Catheter Cardiovasc Interv 98 , 66-75, doi:10.1002/ccd.29111 (2021). Her, A. Y. et al. Drug-coated balloon treatment in coronary artery disease: Recommendations from an Asia-Pacific Consensus Group. Cardiol J 28 , 136-149, doi:10.5603/CJ.a2019.0093 (2021). Rhee, T. M. et al. Impact of Optimized Procedure-Related Factors in Drug-Eluting Balloon Angioplasty for Treatment of In-Stent Restenosis. JACC Cardiovasc Interv 11 , 969-978, doi:10.1016/j.jcin.2018.02.002 (2018). Lansky, A. J. et al. Non-polymer-based paclitaxel-coated coronary stents for the treatment of patients with de novo coronary lesions: angiographic follow-up of the DELIVER clinical trial. Circulation 109 , 1948-1954, doi:10.1161/01.CIR.0000127129.94129.6F (2004). Colombo, A. et al. Randomized study to assess the effectiveness of slow- and moderate-release polymer-based paclitaxel-eluting stents for coronary artery lesions. Circulation 108 , 788-794, doi:10.1161/01.CIR.0000086926.62288.A6 (2003). Stone, G. W. et al. Improved procedural results of coronary angioplasty with intravascular ultrasound-guided balloon sizing: the CLOUT Pilot Trial. Clinical Outcomes With Ultrasound Trial (CLOUT) Investigators. Circulation 95 , 2044-2052, doi:10.1161/01.cir.95.8.2044 (1997). Azuma, A. et al. Quantitative measurements of balloon-to-artery ratios in coronary angioplasty. J Cardiol 21 , 879-888 (1991). Nichols, A. B., Smith, R., Berke, A. D., Shlofmitz, R. A. & Powers, E. R. Importance of balloon size in coronary angioplasty. J Am Coll Cardiol 13 , 1094-1100, doi:10.1016/0735-1097(89)90267-2 (1989). Kitahara, H. et al. Impact of Stent Size Selection on Acute and Long-Term Outcomes After Drug-Eluting Stent Implantation in De Novo Coronary Lesions. Circ Cardiovasc Interv 10 , doi:10.1161/CIRCINTERVENTIONS.116.004795 (2017). Goto, K. et al. Lumen Measurements From Quantitative Coronary Angiography and IVUS: A PROSPECT Substudy. JACC Cardiovasc Imaging 9 , 1011-1013, doi:10.1016/j.jcmg.2015.07.006 (2016). Gao, X. F. et al. 3-Year Outcomes of the ULTIMATE Trial Comparing Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation. JACC Cardiovasc Interv 14 , 247-257, doi:10.1016/j.jcin.2020.10.001 (2021). Zhang, J. et al. Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation: The ULTIMATE Trial. J Am Coll Cardiol 72 , 3126-3137, doi:10.1016/j.jacc.2018.09.013 (2018). Hong, S. J. et al. Effect of Intravascular Ultrasound-Guided vs Angiography-Guided Everolimus-Eluting Stent Implantation: The IVUS-XPL Randomized Clinical Trial. JAMA 314 , 2155-2163, doi:10.1001/jama.2015.15454 (2015). Lee, S. Y. et al. Procedural Characteristics of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention and Their Clinical Implications. J Am Heart Assoc 11 , e025258, doi:10.1161/JAHA.122.025258 (2022). Kang, W. C. et al. Predictors of Favorable Angiographic Outcomes After Drug-Coated Balloon Use for de novo Small Vessel Coronary Disease (DCB-ONLY). Angiology 72 , 986-993, doi:10.1177/00033197211015534 (2021). Kastrati, A. et al. Predictive factors of restenosis after coronary stent placement. J Am Coll Cardiol 30 , 1428-1436, doi:10.1016/s0735-1097(97)00334-3 (1997). Kasaoka, S. et al. Angiographic and intravascular ultrasound predictors of in-stent restenosis. J Am Coll Cardiol 32 , 1630-1635, doi:10.1016/s0735-1097(98)00404-5 (1998). Daniel, W. C. et al. Incidence and treatment of elastic recoil occurring in the 15 minutes following successful percutaneous transluminal coronary angioplasty. Am J Cardiol 78 , 253-259, doi:10.1016/s0002-9149(96)00273-1 (1996). Gijsen, F. et al. Expert recommendations on the assessment of wall shear stress in human coronary arteries: existing methodologies, technical considerations, and clinical applications. Eur Heart J 40 , 3421-3433, doi:10.1093/eurheartj/ehz551 (2019). Kim, S. et al. Favorable Vasomotor Function after Drug-Coated Balloon-Only Angioplasty of De Novo Native Coronary Artery Lesions. J Clin Med 11 , doi:10.3390/jcm11020299 (2022). Horie, K., Tanaka, A., Taguri, M. & Inoue, N. Impact of Scoring Balloons on Percutaneous Transluminal Angioplasty Outcomes in Femoropopliteal Lesions. J Endovasc Ther 27 , 481-491, doi:10.1177/1526602820914618 (2020). Schmidt, T. et al. Safety and efficacy of lesion preparation with the AngioSculpt Scoring Balloon in left main interventions: the ALSTER Left Main registry. EuroIntervention 11 , 1346-1354, doi:10.4244/EIJY15M05_04 (2016). Kufner, S. et al. Neointimal Modification With Scoring Balloon and Efficacy of Drug-Coated Balloon Therapy in Patients With Restenosis in Drug-Eluting Coronary Stents: A Randomized Controlled Trial. JACC Cardiovasc Interv 10 , 1332-1340, doi:10.1016/j.jcin.2017.04.024 (2017). Bonaventura, K. et al. Systematic Scoring Balloon Lesion Preparation for Drug-Coated Balloon Angioplasty in Clinical Routine: Results of the PASSWORD Observational Study. Adv Ther 37 , 2210-2223, doi:10.1007/s12325-020-01320-2 (2020). Shin, E. S. et al. Impact of Scoring Balloon Angioplasty on Lesion Preparation for DCB Treatment of Coronary Lesions. J Clin Med 12 , doi:10.3390/jcm12196254 (2023). Kundu, S., Mazumdar, M. & Ferket, B. Impact of correlation of predictors on discrimination of risk models in development and external populations. BMC Med Res Methodol 17 , 63, doi:10.1186/s12874-017-0345-1 (2017). Suzuki, N. et al. Clinical expert consensus document on quantitative coronary angiography from the Japanese Association of Cardiovascular Intervention and Therapeutics. Cardiovasc Interv Ther 35 , 105-116, doi:10.1007/s12928-020-00653-7 (2020). Cutlip, D. E. et al. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 115 , 2344-2351, doi:10.1161/CIRCULATIONAHA.106.685313 (2007). Additional Declarations No competing interests reported. Supplementary Files SUPPLEMENTARYINFORMATIONFinal.docx Cite Share Download PDF Status: Published Journal Publication published 18 Mar, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 02 Dec, 2024 Reviews received at journal 01 Dec, 2024 Reviews received at journal 11 Nov, 2024 Reviewers agreed at journal 11 Nov, 2024 Reviewers agreed at journal 08 Nov, 2024 Reviewers invited by journal 08 Nov, 2024 Editor assigned by journal 08 Nov, 2024 Editor invited by journal 18 Oct, 2024 Submission checks completed at journal 18 Oct, 2024 First submitted to journal 30 Sep, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5181772","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":367779283,"identity":"f5bc3b47-97a4-4738-a649-541a8cc22019","order_by":0,"name":"Dong Oh Kang","email":"","orcid":"","institution":"Cardiovascular Center, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Dong","middleName":"Oh","lastName":"Kang","suffix":""},{"id":367779284,"identity":"8404bc69-1eea-4e19-b292-c0b8736956e3","order_by":1,"name":"Jong-Seok 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14:53:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5181772/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5181772/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-92052-2","type":"published","date":"2025-03-18T15:56:59+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":67356447,"identity":"094997ab-3485-424a-93a9-051a536fdd0d","added_by":"auto","created_at":"2024-10-24 05:09:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":56384,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCONSORT flow chart of enrollment.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAbbreviations: CTO = chronic total occlusion; DCB = drug-coated balloon; DS = diameter stenosis; SR = optimal DCB result; PCI = percutaneous coronary intervention; Non-SR = non-optimal DCB result\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-5181772/v1/1d5fdd30c993d021a0e140e6.png"},{"id":67356428,"identity":"b426224d-2c88-41cb-a426-67965cabda0a","added_by":"auto","created_at":"2024-10-24 05:09:26","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":109012,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCumulative distribution curve of lesion MLD before and after DCB treatment, and at angiographic follow-up.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAbbreviations: DCB = drug-coated balloon; MLD = minimal luminal diameter; SR, optimal DCB result; Non-SR, non-optimal DCB result\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-5181772/v1/aa01b655a792d6be73cd07af.png"},{"id":67356446,"identity":"91026980-5453-4d56-bd66-9c18e561a2e6","added_by":"auto","created_at":"2024-10-24 05:09:33","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":86197,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eROC curve analyses generated for predicting optimal DCB outcome.\u003c/strong\u003e ROC curves generated by post-DCB MLD \u003cstrong\u003e(Left)\u003c/strong\u003e, balloon-to-artery ratio \u003cstrong\u003e(Middle)\u003c/strong\u003e, and the combined variable of post-DCB MLD and balloon-to-artery ratio \u003cstrong\u003e(Right)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eAbbreviations: AUC = area under the curve; DCB = drug-coated balloon; MLD = minimal luminal diameter; ROC = receiver operating characteristic\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-5181772/v1/7302329879dabc1265fc9639.png"},{"id":67356430,"identity":"fc96628a-d9fa-4db5-bf29-98c3d2fd9dc9","added_by":"auto","created_at":"2024-10-24 05:09:29","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":554096,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGraphical summary of this study.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-5181772/v1/dcfd80d8118a293283f12373.png"},{"id":79120393,"identity":"84727930-0b38-4a47-98b0-2571282d1e17","added_by":"auto","created_at":"2025-03-24 16:05:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2428492,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5181772/v1/027e9f6e-905e-4320-9ea3-01d006883aea.pdf"},{"id":67356449,"identity":"7067d3e7-6967-4951-a3b0-e4f1929e0a3b","added_by":"auto","created_at":"2024-10-24 05:09:37","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":285791,"visible":true,"origin":"","legend":"","description":"","filename":"SUPPLEMENTARYINFORMATIONFinal.docx","url":"https://assets-eu.researchsquare.com/files/rs-5181772/v1/f1a46d4769c80031300c92b7.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Predictors of Optimal Angiographic Lesion Outcomes in Drug-Coated Balloon Treatment for De Novo Coronary Artery Disease: Insights from a Prospective Study and Intravascular Ultrasound Subgroup Analysis","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eDrug-coated balloon (DCB) treatment represents an emerging therapeutic strategy for the management of obstructive coronary artery disease (CAD).\u003csup\u003e1\u003c/sup\u003e Its established safety and efficacy profiles in addressing conditions such as in-stent restenosis (ISR)\u003csup\u003e2\u003c/sup\u003e have spurred ongoing investigations aimed at elucidating its applicability across a broader spectrum of CAD including \u003cem\u003ede novo\u003c/em\u003e native coronary lesions.\u003csup\u003e1\u0026ndash;3\u003c/sup\u003e In a meta-analysis, the use of DCBs was shown to have an efficacy profile comparable to drug-eluting stents (DES) in the treatment of \u003cem\u003ede novo\u003c/em\u003e lesions, resulting in similar outcomes across clinical endpoints, including target lesion or vessel revascularization, myocardial infarction, and mortality.\u003csup\u003e3\u003c/sup\u003e However, DCB treatment was associated with poorer angiographic surrogate endpoint such as a significantly higher percentage diameter stenosis (%DS) and smaller minimal luminal diameter (MLD) at angiographic follow-up.\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOptimal lesion preparation is increasingly recognized as a pivotal step to enhance the efficacy of DCB treatment.\u003csup\u003e1,4\u003c/sup\u003e This approach is instrumental for ensuring effective plaque modification and achieving sufficient luminal gain to restore and accommodate physiologic coronary blood flow. Additionally, it facilitates drug transfer to a broader contact area, thereby enhancing the therapeutic benefits of DCB treatment with the concept of \u0026ldquo;leaving nothing behind\u0026rdquo;. In previous study exploring key procedural factors in treating ISR lesions using DCBs, the predictors of target lesion failure (TLF) included residual DS\u0026thinsp;\u0026ge;\u0026thinsp;20%, DCB-to-stent ratio\u0026thinsp;\u0026le;\u0026thinsp;0.91, and inflation time\u0026thinsp;\u0026le;\u0026thinsp;60 seconds, emphasizing the importance of procedural optimization.\u003csup\u003e5\u003c/sup\u003e However, for \u003cem\u003ede novo\u003c/em\u003e coronary lesions, there has been a lack of studies exploring specific procedure-related factors predictive of successful DCB outcomes. In this study, we aimed to evaluate the prognostic value of various procedure-related factors on angiographic outcomes in patients undergoing DCB treatment for \u003cem\u003ede novo\u003c/em\u003e lesions.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eThis study was based on the all-comers prospective registry that was conducted at Korea University Ansan Hospital from July 2019 to February 2023 (Impact of Drug-Coated Balloon Treatment in De Novo Coronary Lesion; NCT04619277). A total of 308 patients who underwent angiographic follow-up were analyzed. Exclusions were made for individuals with ISR, restenosis after DCB treatment (n\u0026thinsp;=\u0026thinsp;2), heavily calcified lesions treated by rotational atherectomy (n\u0026thinsp;=\u0026thinsp;1), coronary lesions in grafted vessels or transplanted hearts (n\u0026thinsp;=\u0026thinsp;1), and coronary lesions unsuitable for QCA measurement, such as chronic total occlusion lesions (n\u0026thinsp;=\u0026thinsp;5) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThis study specifically focused on identifying crucial procedural steps to achieve favorable angiographic results comparable to those of DESs. Given that earlier studies reported a mean %DS of approximately 20% after paclitaxel-based DES implantation (\u003cb\u003eSupplementary Table\u0026nbsp;1\u003c/b\u003e and \u003cb\u003eSupplementary Fig.\u0026nbsp;1\u003c/b\u003e),\u003csup\u003e6,7\u003c/sup\u003e the study population was categorized into two groups based on follow-up angiographic findings: the SR (successful, stent-like result, %DS\u0026thinsp;\u0026lt;\u0026thinsp;20%, n\u0026thinsp;=\u0026thinsp;224, 358 lesions) group and the Non-SR group (%DS\u0026thinsp;\u0026ge;\u0026thinsp;20%, n\u0026thinsp;=\u0026thinsp;224, 358 lesions) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). During a median follow-up of 24.0 months (interquartile range [IQR]: 13.8\u0026ndash;34.6), the overall incidence of TLF was 5.2% (16/308) in the study population.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eBaseline Clinical Characteristics\u003c/h3\u003e\n\u003cp\u003eThe baseline clinical characteristics of the study population are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. In overall study population treated with DCBs, 78.0% (240/308) presented with acute coronary syndrome, with 26.3% (81/308) experiencing acute MI. Chronic kidney disease was present in 13.3% (41/308) of the patients, while 28.4% (87/308) had left ventricular dysfunction. Baseline clinical characteristics, including demographics, comorbidities, cardiac risk factors, laboratory findings, and angiographic disease extent, were comparable between the SR and Non-SR groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of the study population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall population\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;308)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSR group (DS\u0026thinsp;\u0026lt;\u0026thinsp;20% at FU)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;84)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon-SR group (DS\u0026thinsp;\u0026ge;\u0026thinsp;20% at FU)\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;224)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.7\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.8\u0026thinsp;\u0026plusmn;\u0026thinsp;10.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.985\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (male)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e235 (76.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e172 (76.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.743\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.0\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.0\u0026thinsp;\u0026plusmn;\u0026thinsp;03.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.860\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSBP (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e137.6\u0026thinsp;\u0026plusmn;\u0026thinsp;22.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e140.2\u0026thinsp;\u0026plusmn;\u0026thinsp;22.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e136.6\u0026thinsp;\u0026plusmn;\u0026thinsp;22.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.241\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDBP (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79.5\u0026thinsp;\u0026plusmn;\u0026thinsp;15.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80.5\u0026thinsp;\u0026plusmn;\u0026thinsp;14.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79.1\u0026thinsp;\u0026plusmn;\u0026thinsp;15.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.528\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHR (per min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80.1\u0026thinsp;\u0026plusmn;\u0026thinsp;15.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79.5\u0026thinsp;\u0026plusmn;\u0026thinsp;13.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80.3\u0026thinsp;\u0026plusmn;\u0026thinsp;16.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.716\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMedical comorbidities\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e222 (72.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (69.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e164 (73.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.468\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e132 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (38.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100 (44.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.301\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyslipidemia (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e202 (65.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (59.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e152 (67.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.170\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic kidney disease (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (11.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.656\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnd-stage renal disease (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.619\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent smoker (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75 (24.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (22.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56 (25.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.628\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior MI (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.822\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior PCI (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68 (22.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (22.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49 (21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.888\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrior CVA (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute coronary syndrome (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e240 (77.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e170 (75.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.161\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute MI (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57 (25.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.579\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLV dysfunction (EF\u0026thinsp;\u0026lt;\u0026thinsp;50) (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87 (28.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66 (29.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.413\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLVEF (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57.5 (47.0\u0026ndash;65.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.0 (49.3\u0026ndash;65.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.0 (45.4\u0026ndash;63.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLaboratory findings\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal cholesterol (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e143.0 (116.0\u0026ndash;186.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e151.0 (118.3\u0026ndash;186.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e141.0 (115.0\u0026ndash;186.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.807\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriglyceride (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e126.0 (116.0\u0026ndash;186.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e118.5 (80.0\u0026ndash;179.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e126.0 (89.0\u0026ndash;173.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.836\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDL cholesterol (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.0 (36.0\u0026ndash;50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.0 (36.0\u0026ndash;53.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.0 (36.0\u0026ndash;50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.471\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDL cholesterol (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83.0 (56.5\u0026ndash;119.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.0 (57.5\u0026ndash;118.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80.0 (56.0\u0026ndash;119.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.890\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine (mg/dL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.91 (0.77\u0026ndash;1.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.92 (0.81\u0026ndash;1.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.91 (0.77\u0026ndash;1.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.658\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.10 (5.70\u0026ndash;6.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.0 (5.60\u0026ndash;6.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.20 (5.70\u0026ndash;7.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.238\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehs-CRP (mg/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.12 (0.05\u0026ndash;0.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.13 (0.06\u0026ndash;0.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.11 (0.05\u0026ndash;0.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.372\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAngiographic disease extent\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne-vessel disease (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107 (34.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (41.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72 (32.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.118\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTwo-vessel disease (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118 (38.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90 (40.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.271\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThree-vessel disease (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83 (26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (27.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.637\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eData are expressed as frequency (percent), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, or median (interquartile range). Abbreviations: BMI\u0026thinsp;=\u0026thinsp;body mass index; DBP\u0026thinsp;=\u0026thinsp;diastolic blood pressure; CVA\u0026thinsp;=\u0026thinsp;cerebrovascular accident; FU\u0026thinsp;=\u0026thinsp;follow-up; HbA1c\u0026thinsp;=\u0026thinsp;glycated hemoglobin; hs-CRP\u0026thinsp;=\u0026thinsp;high sensitivity C-reactive protein; HDL\u0026thinsp;=\u0026thinsp;high-density lipoprotein; HR\u0026thinsp;=\u0026thinsp;heart rate; LDL\u0026thinsp;=\u0026thinsp;low-density lipoprotein; LV\u0026thinsp;=\u0026thinsp;left ventricular; LVEF\u0026thinsp;=\u0026thinsp;left ventricular ejection fraction; MI\u0026thinsp;=\u0026thinsp;myocardial infarction; SR\u0026thinsp;=\u0026thinsp;optimal result; PCI\u0026thinsp;=\u0026thinsp;percutaneous coronary intervention; SBP\u0026thinsp;=\u0026thinsp;systolic blood pressure\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eLesion and Procedural Characteristics\u003c/h3\u003e\n\u003cp\u003eIn terms of lesion characteristics (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), 74.3% (335/451) of the target lesions were located in the major epicardial arteries, and 74.7% (337/451) were classified as type B2 or C according to the American College of Cardiology/American Heart Association classification. Lesion location and complexity were similar between the two groups. Quantitatively, angiographic lesion characteristics were comparable, except for a larger RVD in the SR compared to the Non-SR group (2.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48 vs. 2.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47 mm; p\u0026thinsp;=\u0026thinsp;0.001). Specialty balloons (scoring: 96.5% and non-compliant balloon: 3.5%) were more frequently used for lesion preparation in the SR group (54.8% vs. 41.9%; p\u0026thinsp;=\u0026thinsp;0.025). Regarding the DCB profile, the SR group displayed significantly larger values for maximal balloon diameter (3.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52 vs. 2.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48 mm; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and B-A ratio (1.129\u0026thinsp;\u0026plusmn;\u0026thinsp;0.107 vs. 1.095\u0026thinsp;\u0026plusmn;\u0026thinsp;0.109; p\u0026thinsp;=\u0026thinsp;0.008) compared to the Non-SR group. The occurrence of angiographically significant coronary artery dissection did not show any significant difference between the groups. Post-DCB QCA measurements of RVD, MLD, and acute luminal gain showed significantly larger values in the SR group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline lesion characteristics and quantitative angiographic parameter pre- and post-procedure, and at angiographic follow-up\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll lesions\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;451)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSR lesion\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;93)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNon-SR lesion\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;358)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTarget lesion location\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.968\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLAD / Diagonal (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e142 / 47 (41.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32 / 4 (38.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e110/43 (42.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLCX / OM (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e114 / 25 (30.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29 / 4 (35.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e85/21 (29.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRCA / PDA or PLV (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e99 / 30 (23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20 / 2 (23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e79 / 28 (23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRamus intermedius (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16 (3.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eACC/AHA lesion type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.416\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etype A (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23 (6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etype B1 (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e84 (18.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e68 (19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etype B2 (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e162 (35.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40 (43.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e122 (34.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etype C (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e175 (38.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30 (32.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e145 (40.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etype B2 or C (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e337 (74.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70 (75.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e267 (74.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.892\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQCA (pre-procedure)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elesion length (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19.81\u0026thinsp;\u0026plusmn;\u0026thinsp;6.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.88\u0026thinsp;\u0026plusmn;\u0026thinsp;6.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.05\u0026thinsp;\u0026plusmn;\u0026thinsp;6.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.129\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elesion RVD (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elesion MLD (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.75\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.583\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elesion DS (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70.20\u0026thinsp;\u0026plusmn;\u0026thinsp;13.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71.11\u0026thinsp;\u0026plusmn;\u0026thinsp;14.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e69.96\u0026thinsp;\u0026plusmn;\u0026thinsp;13.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.466\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDCB treatment procedure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003especialty balloon used\u003csup\u003e*\u003c/sup\u003e (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e201 (44.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51 (54.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e150 (41.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emax balloon diameter (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eballoon-to-artery ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.102\u0026thinsp;\u0026plusmn;\u0026thinsp;0.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.129\u0026thinsp;\u0026plusmn;\u0026thinsp;0.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.095\u0026thinsp;\u0026plusmn;\u0026thinsp;0.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003edissection (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e157 (34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26 (28.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e131 (36.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.119\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQCA (post-DCB treatment)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elesion RVD (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elesion MLD (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elesion DS (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29.99\u0026thinsp;\u0026plusmn;\u0026thinsp;10.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.70\u0026thinsp;\u0026plusmn;\u0026thinsp;10.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.36\u0026thinsp;\u0026plusmn;\u0026thinsp;10.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eacute luminal gain (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eQCA (Follow-up angiogram)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elesion RVD (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elesion MLD (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elesion DS (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30.50\u0026thinsp;\u0026plusmn;\u0026thinsp;13.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.68\u0026thinsp;\u0026plusmn;\u0026thinsp;3.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34.61\u0026thinsp;\u0026plusmn;\u0026thinsp;12.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elate lumen loss (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e-0.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNet lumen gain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBinary restenosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28 (6.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28 (7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eData are expressed as frequency (percent) or mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. \u003csup\u003e*\u003c/sup\u003eSpecialty balloons includes both scoring (96.5%) and non-compliant (3.5%) balloons. ACC/AHA\u0026thinsp;=\u0026thinsp;American College of Cardiology/American Heart Association; DS\u0026thinsp;=\u0026thinsp;diameter stenosis; LAD\u0026thinsp;=\u0026thinsp;left anterior descending; LCX\u0026thinsp;=\u0026thinsp;left circumflex; MLD\u0026thinsp;=\u0026thinsp;minimal lumen diameter; OM\u0026thinsp;=\u0026thinsp;obtuse marginal; SR\u0026thinsp;=\u0026thinsp;optimal result; PDA\u0026thinsp;=\u0026thinsp;posterior descending artery; PLV\u0026thinsp;=\u0026thinsp;posterior left ventricular; QCA\u0026thinsp;=\u0026thinsp;quantitative coronary angiography; RCA\u0026thinsp;=\u0026thinsp;right coronary artery; RVD\u0026thinsp;=\u0026thinsp;reference vessel diameter\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eAngiographic Follow-up: Vessel Remodeling and MLD Changes\u003c/h3\u003e\n\u003cp\u003eThe median duration from the index PCI to angiographic follow-up was 8.0 months (IQR: 6.0\u0026ndash;11.0). Follow-up QCA measurements of RVD and MLD showed significantly larger values in the SR than in the Non-SR group. In particular, the degree of LLL showed significant difference between the groups (-0.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32 vs. 0.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41 mm; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with the SR group exhibiting a negative mean LLL value, indicative of positive vessel remodeling after DCB treatment. The distribution curves of MLD changes are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Both the SR and Non-SR groups exhibited a significant difference between post-DCB and follow-up MLD measurements in pairwise comparisons. Specifically, MLD measurements significantly increased in the SR group (post-DCB vs. follow-up: 2.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47 vs, 2.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38 mm, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and decreased in the Non-SR group (post-DCB vs. follow-up: 1.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44 vs. 1.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48 mm, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The percentage increase in MLD was 13.41\u0026thinsp;\u0026plusmn;\u0026thinsp;18.51% in the SR group and \u0026minus;\u0026thinsp;4.20\u0026thinsp;\u0026plusmn;\u0026thinsp;23.32% in the non-SR group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003ePredictors of Successful Angiographic Outcomes: Multivariate Analysis and ROC Curves\u003c/h3\u003e\n\u003cp\u003eIn multivariate logistic regression analysis (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), we systematically examined a wide range of peri-procedural factors including lesion characteristics, procedural parameters, and angiographic QCA measurements, for predicting optimal angiographic outcome. Following forward conditional analysis, post-DCB MLD (per 0.1 mm increase; odds ratio [SR] 1.168, 95% confidence interval [CI] 1.141\u0026ndash;1.198; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and B-A ratio (per 0.1 increase; SR 1.432, 95% CI 1.318\u0026ndash;1.547; p\u0026thinsp;=\u0026thinsp;0.002) remained as robust independent predictors for successful angiographic outcomes following DCB treatment. In ROC curve analyses, the optimal thresholds for predicting successful DCB outcome based on the Yuden index was determined as 1.945 mm for post-DCB MLD (area under curve [AUC] 0.684) and 1.127 for B-A ratio (AUC 0.578) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Combining these factors increased the overall predictive power to an AUC of 0.703.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate and multivariate logistic regression analysis exploring procedural factors associated with optimal angiographic outcome\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnivariate analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eMultivariate analysis*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesion location (LAD, LCX, RCA, and RI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.260 (0.143\u0026ndash;0.376)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eACC/AHA lesion type (B2C)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.037 (0.768\u0026ndash;1.307)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.892\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecialty balloon used\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.684 (1.450\u0026ndash;1.918)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccurrence of angiographic dissection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.672 (0.417\u0026ndash;0.928)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximum balloon diameter (per 1.0 mm increase)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.014 (2.784\u0026ndash;3.244)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB-A ratio (per 0.1 increase)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.323 (1.216\u0026ndash;1.430)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.432 (1.318\u0026ndash;1.547)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-DCB lesion length (per 1.0 mm increase)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.973 (0.955\u0026ndash;0.991)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-DCB RVD (per 0.1 mm increase)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.078 (1.054\u0026ndash;1.102)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-DCB MLD (per 0.1 mm increase)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.018 (0.986\u0026ndash;1.049)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.582\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-DCB %DS (per 1.0% increase)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.001 (1.000\u0026ndash;1.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.465\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-DCB RVD (per 0.1 mm increase)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.082 (1.057\u0026ndash;1.107)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-DCB MLD (per 0.1 mm increase)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.158 (1.131\u0026ndash;1.184)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.168 (1.141\u0026ndash;1.195)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-DCB %DS (per 1.0% increase)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.994 (0.992\u0026ndash;0.995)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute luminal gain (per 0.1 mm increase)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.116 (1.093\u0026ndash;1.139)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e*\u003c/sup\u003eThe variables included in the multivariate logistic regression analysis, using the forward conditional method, are as follows: lesion length, RVD, MLD and %DS before and after DCB treatment, acute luminal gain, max balloon diameter, B-A ratio, use of specialty balloon, occurrence of angiographic dissection, target lesion location, and ACC/AHA lesion classification type. Abbreviations: ACC/AHA\u0026thinsp;=\u0026thinsp;American College of Cardiology/American Heart Association; B-A\u0026thinsp;=\u0026thinsp;balloon-to-artery; CI\u0026thinsp;=\u0026thinsp;confidence interval; DCB\u0026thinsp;=\u0026thinsp;drug-coated balloon; DS\u0026thinsp;=\u0026thinsp;diameter stenosis; LAD\u0026thinsp;=\u0026thinsp;left anterior descending; LCX\u0026thinsp;=\u0026thinsp;left circumflex; MLD\u0026thinsp;=\u0026thinsp;minimal luminal diameter; SR\u0026thinsp;=\u0026thinsp;odds ratio; RCA right coronary artery; RI\u0026thinsp;=\u0026thinsp;ramus intermedius; RVD\u0026thinsp;=\u0026thinsp;reference vessel diameter\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eImpact of IVUS Guidance on Vessel Measurements and Balloon Sizing\u003c/h2\u003e \u003cp\u003eOur study included a subgroup of 47 patients who received IVUS-guided DCB treatment for a total of 56 \u003cem\u003ede novo\u003c/em\u003e lesions. We compared IVUS measurements and the balloon sizes utilized in these procedures with the RVD obtained from QCA (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Compared to QCA, IVUS revealed significantly larger vessel diameters based on the external elastic membrane diameter. The nominal diameter of pre-dilation balloons chosen by attending interventionists was 11% greater compared to QCA-derived RVD (B-A ratio: 1.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14). Ultimately, IVUS guidance resulted in a final B-A ratio of 1.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14, as calculated by QCA.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of QCA versus IVUS-based vessel sizing and final balloon diameter in patients treated by IVUS-guided DCB PCI\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVessel size measurements\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll lesions (n\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReference vessel diameter (RVD, interpolated by QCA) (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistal reference lumen diameter (by IVUS) (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistal reference EEM diameter (by IVUS) (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProximal reference lumen diameter (by IVUS) (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProximal reference EEM diameter (by IVUS) (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLumen diameter at the worst stenosis (by IVUS) (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEEM diameter at the worst stenosis (by IVUS) (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIVUS measurements vs. QCA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRatio (n\u0026thinsp;=\u0026thinsp;56)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistal reference EEM diameter-to-RVD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistal reference lumen diameter-to-RVD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLesion EEM diameter (at the worst stenosis)-to-RVD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIVUS-guided balloon size vs. QCA-RVD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eRatio (n\u0026thinsp;=\u0026thinsp;56)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-dilation balloon diameter\u003csup\u003e\u0026dagger;\u003c/sup\u003e (at nominal pr.)-to-RVD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximal balloon diameter\u003csup\u003e\u0026Dagger;\u003c/sup\u003e-to-RVD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003csup\u003e*\u003c/sup\u003eIndicates statistically significant difference compared to QCA-derived RVD (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). \u003csup\u003e\u0026dagger;\u003c/sup\u003eIndicates the size of the balloon chosen by the attending interventionist to pre-dilate the target lesion based on IVUS assessment. \u003csup\u003e\u0026Dagger;\u003c/sup\u003eMaximal balloon diameter refers to the greatest diameter of either the pre-dilation balloon or the DCB, as actually inflated during the procedure.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eAbbreviations: DCB\u0026thinsp;=\u0026thinsp;drug-coated balloon; EEM\u0026thinsp;=\u0026thinsp;external elastic membrane; IVUS\u0026thinsp;=\u0026thinsp;intravascular ultrasound; PCI\u0026thinsp;=\u0026thinsp;percutaneous coronary intervention; QCA\u0026thinsp;=\u0026thinsp;quantitative coronary angiography; RVD\u0026thinsp;=\u0026thinsp;reference vessel diameter\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DICUSSION","content":"\u003cp\u003eIn this all-comer prospective study, we investigated the prognostic significance of various procedural characteristics on angiographic outcomes of DCB treatment for \u003cem\u003ede novo\u003c/em\u003e coronary lesions. The key findings of the present study were as follows: First, notable disparities were observed in procedural characteristics between the lesions demonstrating successful, stent-like DCB results (SR) at angiographic follow-up and those not (Non-SR), particularly with the use of balloons with larger B-A ratio identified as an independent predictor of the success. Second, the significance of this distinct procedural step was corroborated by an improved immediate post-DCB angiographic outcomes, with a greater acute luminal gain and a larger MLD. Finally, these differences ultimately translated into a more favorable follow-up angiographic outcome in the SR group, characterized by a larger final MLD and positive vessel remodeling (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eCurrent expert consensus documents commonly recommend a B-A ratio of approximately 0.8 to 1.0 for DCB angioplasty.\u003csup\u003e1,4\u003c/sup\u003e This recommended range considered to balance adequate lesion expansion and drug delivery against the potential risks of vessel injury. However, these recommendations are largely based on expert experience and consensus opinion, rather than robust clinical data.\u003csup\u003e1,4\u003c/sup\u003e Moreover, these guidelines do not provide detailed guidance on the measurement methods for determining RVD, such as whether visual assessment or QCA should be used, or whether to consider the distal, proximal, or mean RVD.\u003c/p\u003e \u003cp\u003eHistorically, in the pre-stent, percutaneous transluminal coronary angioplasty (PTCA) era, a higher B-A ratio of \u0026gt;\u0026thinsp;1.0 was often suggested.\u003csup\u003e8,9\u003c/sup\u003e Specifically, lesion preparation conducted by balloons with B-A ratio ranging from 0.9 to 1.3, as assessed by cine angiography, yielded optimal outcomes by minimizing dissections and residual stenosis.\u003csup\u003e10\u003c/sup\u003e The positive impact of oversized devices on procedural and clinical outcomes was also well documented for the DES therapy.\u003csup\u003e11\u003c/sup\u003e These insights from the historical studies are particularly relevant to our findings, emphasizing the importance of oversized ballooning in lesion preparation. Specifically, our data demonstrated that a 0.1 increase in the B-A ratio was associated with 43.2% increase in the odds of achieving favorable angiographic outcome at the median 8-month follow-up. Collectively, the current B-A ratio recommendations in DCB treatment for \u003cem\u003ede novo\u003c/em\u003e CAD should be refined to establish optimal ranges and safety limits in light of this context.\u003c/p\u003e \u003cp\u003eIt is widely acknowledged that RVD is typically larger by intravascular imaging (IVI) than by angiography.\u003csup\u003e12\u003c/sup\u003e An earlier study by Stone GW et al. demonstrated that IVUS-guidance, compared to angiography-guided PTCA, resulted in balloon upsizing in 73% of participants, increasing B-A ratio from 1.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.15 to 1.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003csup\u003e8\u003c/sup\u003e This IVUS-guided PTCA led to a significant decrease in mean angiographic %DS and an increase in MLD, without significantly increasing peri-procedural complications.\u003csup\u003e8\u003c/sup\u003e The benefits of IVUS- versus angiography-guided PCI have also been well recognized in DES therapy.\u003csup\u003e13,14\u003c/sup\u003e In the ULTIMATE trial, IVUS-guided PCI led to more frequent post-dilation using larger balloons at higher pressures, resulting in a significantly greater MLD after DES implantation.\u003csup\u003e13,14\u003c/sup\u003e These specific procedural characteristics are suggested to translate into improved clinical outcomes.\u003csup\u003e13,14\u003c/sup\u003e Furthermore, a pooled analysis based on two randomized clinical trials (IVUS-XPL and ULTIMATE), stent oversizing of stent-to-vessel ratio of 1.1 to 1.3 was associated with better angiographic and clinical outcomes.\u003csup\u003e13\u0026ndash;16\u003c/sup\u003e Given these insights, there is a growing need to explore how IVI guidance can influence DCB treatment in \u003cem\u003ede novo\u003c/em\u003e CAD. Our analysis provides evidence that IVUS guidance led to a higher B-A ratio of 1.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14 through a more detailed assessment of target lesion anatomy. Further studies are warranted to determine more detailed, systematic balloon sizing strategy based on IVI and its impact on patient outcomes after DCB treatment.\u003c/p\u003e \u003cp\u003eA previous study demonstrated that post-procedural MLD significantly predicted successful DCB treatment in \u003cem\u003ede novo\u003c/em\u003e lesions.\u003csup\u003e17\u003c/sup\u003e Our study consistently demonstrated these findings, underscoring the importance of achieving sufficient luminal enlargement immediately after the procedure. Numerous studies on stent-based PCI have consistently shown a strong association between larger final stent dimensions and reduced rates of ISR, supporting the concept of \u0026ldquo;the larger, the better\u0026rdquo;.\u003csup\u003e14,16,18,19\u003c/sup\u003e In the context of DCB treatment, this relationship is particularly pertinent since DCBs, unlike stents, do not provide scaffolding to maintain vessel patency. Evidences from the PTCA era showed that repeated balloon overstretch using balloons with bigger B-A ratio alleviated early vessel recoil.\u003csup\u003e20\u003c/sup\u003e Furthermore, adequate luminal gain after PCI might facilitate the restoration of coronary laminar flow, leading to a favorable shear stress environment. Shear stress, the force exerted by blood flow on the vessel wall, plays a pivotal role in vascular biology and regulating vessel healing.\u003csup\u003e21\u003c/sup\u003e In the case of DCB treatment, enlarged lumen without residual metallic scaffold might promote a favorable hemodynamic microenvironment, potentially reducing the risks of abnormal vasomotion, thrombus formation, and neointimal proliferation/restenosis.\u003csup\u003e21,22\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn our study, specialty balloons, predominantly scoring balloons, were more frequently used in SR group. However, they were not identified as an independent predictor in the multivariable logistic regression analysis. This observation should be interpreted with caution, as it does not necessarily imply that scoring balloons are ineffective. Rather, their impact may be overshadowed in the presence of stronger predictive factors such as B-A ratio or post-DCB MLD. Scoring balloons play a crucial role in controlled plaque modification, achieving sufficient luminal gain, and reducing the risk of serious vessel injury during the course of various endovascular intervention.\u003csup\u003e23,24\u003c/sup\u003e Their positive impact in DCB treatment was well demonstrated in treating ISR.\u003csup\u003e25,26\u003c/sup\u003e A recent study demonstrated that the utilization of a scoring balloon was associated with reduced risk of severe dissection and more favorable angiographic outcomes in treating \u003cem\u003ede novo\u003c/em\u003e coronary lesions.\u003csup\u003e27\u003c/sup\u003e Accordingly, despite the larger maximum balloon diameter and B-A ratio observed in the SR group compared to the Non-SR group, there was no significant difference in the occurrence of coronary dissection in our study. These findings underscore the complexity of factors influencing DCB treatment outcomes and suggests that scoring balloons might still play a valuable, albeit not singularly decisive, role within the broader context of procedural strategy. Further research is needed to fully understand their role, especially in the treatment of complex lesions where controlled plaque modification and effective drug delivery are crucial.\u003c/p\u003e \u003cp\u003eIn our study, only paclitaxel-coated balloons were used, which limits the generalizability of our findings to limus-coated balloons. The AUC value obtained from the ROC analysis for the B-A ratio was relatively modest. Given the current recommendation of a B-A ratio between 0.8 and 1.0, attending interventionists tend to adhere closely this range, resulting in constrained variability in B-A ratio values.\u003csup\u003e1,4\u003c/sup\u003e Such limited variability or high correlation among procedural variables can compromise the discriminatory capacity of ROC model, thereby yielding a lower AUC.\u003csup\u003e28\u003c/sup\u003e Analyzing a more extensive dataset and incorporating diverse pre-dilation strategies in the future studies may contribute to achieving higher AUC values.\u003c/p\u003e \u003cp\u003eOur study contributes significantly to the ongoing discussion about the optimal procedural steps and the appropriate application of DCB therapeutic strategies in \u003cem\u003ede novo\u003c/em\u003e CAD. Given the historical precedents in the PTCA era and insights from stent therapy, specifically the concept of \u0026ldquo;the larger, the better\u0026rdquo;, our findings suggest the potential benefits of considering a higher B-A ratio to achieve maximal final MLD for successful DCB treatment. Future research, especially studies incorporating IVI, is essential to further optimize DCB treatment strategies and improve patient outcomes.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStudy Population\u003c/h2\u003e \u003cp\u003eThis study was based on the all-comers prospective registry that was conducted at Korea University Ansan Hospital from July 2019 to February 2023 (Impact of Drug-Coated Balloon Treatment in De Novo Coronary Lesion; NCT04619277). This registry encompasses patients with significant CAD undergoing DCB-based percutaneous coronary intervention (PCI) with either DCB-only, or in combination with drug-eluting stent (DES) implantation for \u003cem\u003ede novo\u003c/em\u003e lesions in native coronary arteries. Patients were excluded if they had a life expectancy of less than two years or declined to provide consent. Those with suboptimal DCB treatment procedures, characterized by delayed DCB delivery (exceeding 60 seconds), failure to deliver DCB at least by the second attempt, or insufficient inflation time (less than 30 seconds), were also ineligible. Patients underwent clinical follow-up after the index procedure through regularly scheduled outpatient clinic visits at 3- to 5- months interval or telephone interviews were conducted in cases where in-person visits were unavailable.\u003c/p\u003e \u003cp\u003eThis study analyzed a total of 317 patients underwent DCB-based PCI for \u003cem\u003ede novo\u003c/em\u003e CAD and angiographic follow-up (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). We further analyzed a subgroup of 47 patients who underwent intravascular ultrasound (IVUS)-guided DCB treatment in our cohort. This study was conducted in accordance with the Declaration of Helsinki (2013). Ethical approval was granted by the Ethics Committee of Korea University Ansan Hospital, with approval number [2019AS0162]. Written informed consent was obtained from all participants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eDCB Treatment Procedure\u003c/h2\u003e \u003cp\u003eThe DCB treatment procedure adhered to international and Asia-Pacific consensus recommendations, involving aggressive pre-dilation using a semi-compliant balloon, non-compliant balloon, or scoring balloon, as determined by the attending interventionist's discretion.\u003csup\u003e1,4\u003c/sup\u003e Our DCB registry meticulously records detailed information throughout the DCB treatment procedural steps, encompassing the types of pre-dilation balloon (semi-compliant, non-compliant, or scoring), the length and diameter of the balloons, and the maximum inflation pressure and diameter achieved during balloon inflation. In cases of type A to C dissections following pre-dilation, stenting was deferred unless flow limitation developed. Bail-out stenting was reserved for type D or more severe coronary dissections. The DCBs used were all paclitaxel-based devices (SeQuent Please or SeQuent Please NEO: B. Braun Melsungen AG, Melsungen, Germany) and inflated for a minimum of 30 seconds, mostly extending beyond 60 seconds, based on the attending interventionist's discretion.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eDefinition of Successful Angiographic Results\u003c/h2\u003e \u003cp\u003eThis study specifically focused on identifying crucial procedural steps to achieve favorable angiographic results comparable to those of DESs. Earlier studies that compared paclitaxel-based DES versus bare metal stent reported a mean %DS of 20.2%, ranging from 17.4 to 26.1%, in DES arm at angiographic follow-up (\u003cb\u003eSupplementary Table\u0026nbsp;1\u003c/b\u003e and \u003cb\u003eSupplementary Fig.\u0026nbsp;1\u003c/b\u003e).\u003csup\u003e6,7\u003c/sup\u003e In the present study, a successful, stent-like DCB treatment result was defined as DCB-treated lesions exhibiting %DS less than 20%, with no signs of residual dissection or aneurysmal deformation observed at angiographic follow-up. The study population was categorized into two groups based on follow-up angiographic findings: the SR (successful, stent-like result, %DS\u0026thinsp;\u0026lt;\u0026thinsp;20%) group and the Non-SR group (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eCoronary angiography and Quantitative Coronary Angiography (QCA) Analysis\u003c/h2\u003e \u003cp\u003eA minimum of two orthographic views were obtained to assess pre-procedural and post-procedural angiographic characteristics of the target lesions. Follow-up angiographies were recorded with projection angles similar to the final angiographies of the index procedure. The procedural efficacy and angiographic outcomes of DCB treatment were quantitatively assessed using QCA measurements. High-resolution angiograms, obtained using a standardized protocol, were digitally stored and analyzed with a dedicated QCA software system (e.g., CAAS II QCA, Pie Medical Imaging BV, Maastricht, The Netherlands). Two expert researchers (Jiho Hyun and Hye Young Heo), blinded to the study purpose, measured the QCA parameters before, immediately after the DCB treatment, and during the follow-up angiography. These measurements included lesion length, reference vessel diameter (RVD), MLD, %DS, and acute luminal gain, as per established recommendations.\u003csup\u003e29\u003c/sup\u003e Specifically, RVD was derived by an interpolated method, a broadly accepted and well-validated method by QCA.\u003csup\u003e29\u003c/sup\u003e Balloon-to-artery ratio (B-A ratio) was calculated as the maximal diameter of either pre-dilation balloon or DCB, whichever was larger, actually inflated during each procedure, divided by the target lesion RVD. Positive vessel remodeling was defined, according to QCA, as a target lesion exhibiting a negative value in LLL.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eClinical follow-up and study endpoints\u003c/h2\u003e \u003cp\u003eClinical endpoint was target lesion failure (TLF), a composite of cardiac death, target vessel myocardial infarction (MI; excluding periprocedural MI and which not clearly linked to the target vessel), and clinically-driven target lesion revascularization at the longest follow-up available. Cardiac death was defined as any death that was not clearly of extracardiac origin, including MI. Clinically-driven target lesion revascularization was defined based on angiographic findings of %DS\u0026thinsp;\u0026ge;\u0026thinsp;50% during follow-up, accompanied by one or more of the following criteria: recurrent angina pectoris related to the target vessel, objective ischemic signs at rest or during exercise tests, abnormal fractional flow reserve results, or when %DS was \u0026ge;\u0026thinsp;70%, even without ischemic signs or symptoms, in adherence to the Academic Research Consortium criteria.\u003csup\u003e30\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eContinuous variables are expressed as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations and dichotomous variables as counts and percentages. QCA measurements obtained before and immediately after DCB treatment, as well as those obtained at angiographic follow-up, were compared between the SR and Non-SR lesions. Continuous variables were compared using Student\u0026rsquo;s t-test or Mann\u0026ndash;Whitney U-test, and categorical variables were compared using Pearson\u0026rsquo;s chi-square or Fisher\u0026rsquo;s exact test. Paired measurements were analyzed using the paired t-test to assess differences. Stepwise binary logistic regression analysis explored the potential association between procedure-related factors and angiographically successful DCB results. Covariates that showed statistical significance in the univariate analysis or deemed clinically important were included in the multivariate analysis using the forward conditional method. Receiver-operating characteristic (ROC) curves were generated for a specific procedural factor to determine the optimal threshold value for predicting favorable angiographic outcomes (the MedCalc software, version 22.021, Ostend, Belgium). Statistical analyses were performed using the SPSS software (version 20.0; IBM Corp., Armonk, NY, USA) and statistical significance was set at p-values of \u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank Hangseok Choi for statistical analysis; Ji Ho Hyun and Hye Young Heo for their assistance in measuring QCA; and Minjung Lee and Hye Young Heo for the administrative assistance in managing the research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eD.O.K., E-S.S., and S.K. conceptualized the study. E-S.S. and S.K. designed the study protocol. D.O.K., S.K., A-Y.H. and E-S.S. wrote the original manuscript. S.K., J-S.L., Y-H.K., S-Y.L., S.H.K., J-C.A., and W-H.S. contributed to the data acquisition. D.O.K., S.K., B.K. and E-S.S. supervised analysis and interpretation. S.K., J-S.L., Y-H.K., S-Y.L., S.H.K., J-C.A., and W-H.S. contributed to data analyses and interpretation. All the authors have read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe corresponding author has full access to the study data, and anonymized data will be available upon reasonable request from a qualified researcher.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdditional Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have nothing to disclose and declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSources of Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is funded by the Grants from National Research Foundation of Korea (NRF) funded by the Korean government [Grant number: NRF-2021R1F1A1061337 to S.K.][Grant number:\u0026nbsp;RS-2023-00210960 to D.O.K.], Korea University Grant [Grant number K1923481, K2022971, K2111151, and K2211921 to S.K.; and\u0026nbsp;K2225581 to D.O.K.].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTwitter Handle\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAchieving maximal post-DCB lumen gain through oversized ballooning was identified as the key predictor for favorable angiographic outcomes after DCB treatment for \u003cem\u003ede novo\u003c/em\u003e coronary artery disease, underscoring the need for refining lesion predilation strategies.(#Drug-coated Balloons, , #De novo CAD, #Maximal post-DCB lumen gain, #Lesion predilation, and #Oversized ballooning)\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eJeger, R. 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E.\u003cem\u003e et al.\u003c/em\u003e Clinical end points in coronary stent trials: a case for standardized definitions. \u003cem\u003eCirculation\u003c/em\u003e \u003cstrong\u003e115\u003c/strong\u003e, 2344-2351, doi:10.1161/CIRCULATIONAHA.106.685313 (2007).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"coronary artery disease, drug-coated balloon, lesion predilation, oversized ballooning, balloon-to-artery ratio","lastPublishedDoi":"10.21203/rs.3.rs-5181772/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5181772/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eDrug-coated balloon (DCB) treatment is an emerging strategy for \u003cem\u003ede novo\u003c/em\u003e coronary artery disease (CAD), but procedural optimization remains uncertain. This study analyzed 317 patients who underwent DCB-based intervention for \u003cem\u003ede novo\u003c/em\u003e CAD and angiographic follow-up: SR (successful, stent-like result: diameter stenosis \u0026lt;20% at follow-up angiography, n=84, 93 lesions) and Non-SR (n=224, 358 lesions) groups. Baseline clinical and lesion characteristics were similar, except that SR lesions had larger diameter. In SR lesions, specialty balloons were more frequently utilized (p=0.025), and maximal balloon diameter and balloon-to-artery ratio were significantly greater compared to Non-SR lesions (p\u0026lt;0.001 and p=0.008). At a median 8-month follow-up, SR lesions exhibited larger minimal luminal diameter (MLD) and lower late lumen loss, with negative values indicating positive vessel remodeling. In multivariate analysis, post-DCB MLD (odds ratio 1.17 per 0.1mm increase, p\u0026lt;0.001) and balloon-to-artery ratio (odds ratio 1.43 per 0.1 increase, p=0.002) were independent predictors for successful angiographic outcomes with thresholds of 1.95 mm for post-DCB MLD and 1.13 for balloon-to-artery ratio. In 47 patients, IVUS guidance resulted in balloon-to-artery ratio of 1.23 as calculated by QCA. The study demonstrated the importance of achieving maximal post-DCB MLD through aggressive lesion predilation, underscoring the need for refining procedural strategies.\u003c/p\u003e","manuscriptTitle":"Predictors of Optimal Angiographic Lesion Outcomes in Drug-Coated Balloon Treatment for De Novo Coronary Artery Disease: Insights from a Prospective Study and Intravascular Ultrasound Subgroup Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-24 05:08:44","doi":"10.21203/rs.3.rs-5181772/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-12-03T02:58:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-01T13:25:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-11T08:26:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"65508183161067766664346079809512514512","date":"2024-11-11T05:21:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"178064655459406343743490096186587386785","date":"2024-11-09T01:31:10+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-08T17:37:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-08T17:30:44+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-10-18T16:43:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-18T16:30:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-09-30T14:47:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f19a7a2a-201d-48b4-a4a9-834e1deca710","owner":[],"postedDate":"October 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":39138931,"name":"Health sciences/Cardiology/Cardiac device therapy"},{"id":39138932,"name":"Health sciences/Cardiology/Interventional cardiology"}],"tags":[],"updatedAt":"2025-03-24T15:59:21+00:00","versionOfRecord":{"articleIdentity":"rs-5181772","link":"https://doi.org/10.1038/s41598-025-92052-2","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-03-18 15:56:59","publishedOnDateReadable":"March 18th, 2025"},"versionCreatedAt":"2024-10-24 05:08:44","video":"","vorDoi":"10.1038/s41598-025-92052-2","vorDoiUrl":"https://doi.org/10.1038/s41598-025-92052-2","workflowStages":[]},"version":"v1","identity":"rs-5181772","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5181772","identity":"rs-5181772","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}