Abstract Body: Introduction: Coronary artery calcification (CAC), a hallmark of advanced atherosclerosis, is driven by inflammatory cytokines like TNF-α, IL-6, and ICAM-1, worsening outcomes Post-Per Cutaneous Coronary Intervention (PCI). Drug-coated balloons (DCBs) offer a stent-free alternative to drug-eluting stents (DES) in CAC, but their anti-inflammatory mechanisms remain unclear. This study evaluates DCB-induced TNF-α suppression and its link to clinical and angiographic outcomes.
Hypothesis: DCBs reduce inflammation-driven calcification via TNF-α modulation, improving procedural success and lowering major adverse cardiac events (MACE).
Methods: A systematic review (2020–2025) of PubMed, EMBASE, and Cochrane Library identified studies evaluating DCB use in CAC. Inclusion criteria required reporting pre- and post-procedural inflammatory markers (TNF-α, IL-6, ICAM-1) or MACE (cardiac death, myocardial infarction, target lesion revascularization). Three studies (n=1,218) were analyzed using random-effects models and mixed regression.
Results: DCBs significantly reduced TNF-α in calcified lesions (41.78±6.21 vs. 37.91±5.89 pg/mL; p=0.018), with greater reductions in severe calcification (Δ=−6.3 vs. −2.1 pg/mL; p=0.03). No changes in IL-6 (2.55±1.02 vs. 3.11±1.34 pg/mL; p=0.18) or ICAM-1 (14.11±3.45 vs. 13.91±3.12 ng/mL; p=0.62) were observed. MACE rates in calcified lesions (11.3%; 95% CI:8.2–14.4%) matched non-calcified lesions (9.8%; p=0.24). Angiographic success was 92%, with lower stent deformation vs. DES (4% vs. 12%; p=0.01). DCBs showed non-inferior late lumen loss to DES (0.24±0.18 vs. 0.27±0.21 mm; p=0.15). Subgroup analysis linked baseline TNF-α >50 pg/mL to higher 12-month TLR (18.7% vs. 8.9%; p=0.004).
Conclusions: DCBs selectively suppress TNF-α in CAC, correlating with reduced restenosis and high procedural success. While IL-6/ICAM-1 remained unaffected, TNF-α modulation positions DCBs as viable DES alternatives in complex CAC. Limitations include short follow-up and protocol heterogeneity. Future studies should standardize lesion preparation and extend cytokine monitoring.