Background: Bifurcation lesions pose unique challenges during percutaneous coronary intervention (PCI) and are associated with suboptimal outcomes. The standard approach involves provisional stenting of the main branch (MB) with plain balloon angioplasty (BA) for compromised side branches (SBs). It remains unclear whether drug-coated balloon (DCB) or plain balloon angioplasty pose a better strategy to treat SB in bifurcation lesions. This systematic review and meta-analysis compared the efficacy of DCB versus BA in managing SBs of bifurcation lesions.

Methods: MEDLINE, Cochrane, and EMBASE databases were searched for randomized controlled trials (RCTs) comparing DCB and BA for treating bifurcation lesions. Outcomes included SB late lumen loss (LLL), major adverse cardiovascular events (MACE), all-cause mortality, myocardial infarction (MI), and target lesion revascularization (TLR).

Results: Five RCTs were included, encompassing 1,255 patients, of whom 628 (50.4%) underwent DCB angioplasty; 946 (75.4%) were male, and the mean age was 63.5 years. Drug-coated balloons significantly reduced MI risk (risk ratio [RR] = 0.56, 95% CI: 0.35-0.88, P = .010). DCB use resulted in similar LLL in the SB compared with BA (mean difference (MD) = −0.12 mm, 95% CI: −0.24-0.01, P = .070). No significant differences were observed in TLR (RR = 1.19, 95% CI: 0.45-3.14, P = .720), MACE (RR = 0.70, 95% CI: 0.48-1.02, P = .070), and all-cause mortality (RR = 2.35, 95% CI: 0.61-9.00, P = .210).

Conclusion: In this meta-analysis of RCTs, DCB significantly reduced MI without affecting LLL, TLR, MACE, and all-cause mortality compared with BA in the SB of bifurcation lesions.