Drug-Coated Balloon in Patients With High Bleeding Risk

NCT ID: NCT05221931

Last Updated: 2025-12-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

1350 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-07-29

Study Completion Date

2028-12-31

Brief Summary

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DCB-HBR trial is prospective, multi-center, open-label, randomized controlled, noninferiority trial.

The aim of the study is to compare clinical outcomes of drug-coated balloon (DCB) with drug-eluting stent (DES) for treatment of de-novo coronary lesion in patients with high bleeding risk (HBR).

Detailed Description

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Second-generation DES is the standard of care for patients with coronary artery disease who are deemed eligible for percutaneous coronary intervention (PCI). Despite many advantages, DES inevitably accompany disadvantages such as the occurrence of late stent thrombosis and the need for maintaining dual antiplatelet (DAPT) for certain period due to permanent vascular implant, which lead to both increased ischemic and bleeding events.

As an alternative to DES, drug-coated balloon (DCB), a novel treatment strategy, which has benefit of having shorter DAPT maintenance duration due to the absence of metallic scaffolds and polymers, has been introduced. Based on meta-analysis based on many randomized clinical trials (RCT), its use has been established in in-stent restenosis of bare-metal stents (BMS) and DES. Furthermore, recently published RCT demonstrated efficacy and safety of DCB in de-novo coronary lesions in small vessels with reference vessel size\<3.0mm. However, studies exploring the feasibility of DCB in de-novo coronary artery stenosis beyond small vessels are limited. Furthermore, there is scarce data comparing DCB with DES in patients with de-novo coronary artery stenosis and high bleeding risk (HBR), a situation in which long-term maintenance of DAPT is a clinical dilemma. In previous BASKET-SMALL 2 trial, DCB showed noninferiority to DES in patients with de-novo coronary artery stenosis and small vessel disease. However, this trial was conducted in non-HBR patients, and the number of participated patients was insufficient. In another RCT, DEBUT trial exclusively enrolled patients with HBR and de-novo coronary artery stenosis. Although the DEBUT trial showed superiority of DCB angioplasty over implantation of BMS to treat de-novo coronary artery stenosis in patients with HBR, the results could not be applicable in contemporary practice because BMS has been no longer in clinical use. Recently, multiple RCTs have proved short-term DAPT (1-3 months) has comparable efficacy to longer term DAPT in HBR patients using latest second-generation DES.

On this background, the current trial aims to compare clinical outcomes between DCB and DES to treat de-novo coronary artery stenosis in patients with HBR receiving guideline-directed short-term DAPT.

Conditions

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Coronary Artery Disease

Keywords

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Percutaneous Coronary Intervention De-Novo Coronary Lesion Drug-Coated Balloon High Bleeding Risk Prognosis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Prospective, multi-center, open-label, randomized controlled, noninferiority trial
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
Clinical outcome assessment will be performed under blinded assessment about the allocated treatment group.

Study Groups

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DES group

Patients will be randomized to either the DCB group or the DES group with 1:1 ratio during the index procedure after diagnostic angiography.

In DES group, latest second-generation DES will be used (Ultimaster Tansei) during the index procedure

Group Type ACTIVE_COMPARATOR

Percutaneous coronary intervention

Intervention Type PROCEDURE

1:1 randomization to DES (Ultimaster Tansei) or DCB (Agent \[Boston Scientific, USA\], Prevail \[Medtronic, USA\], or SeQuent Please, SeQuent Please NEO \[B-Braun, Germany\])

DCB group

Patients will be randomized to either the DCB group or the DES group with 1:1 ratio during the index procedure after diagnostic angiography.

In DCB group, Agent (Boston Scientific, USA), Prevail (Medtronic, USA), or SeQuent Please, SeQuent Please NEO (B-Braun, Germany) will be used during the index procedure.

Group Type EXPERIMENTAL

Percutaneous coronary intervention

Intervention Type PROCEDURE

1:1 randomization to DES (Ultimaster Tansei) or DCB (Agent \[Boston Scientific, USA\], Prevail \[Medtronic, USA\], or SeQuent Please, SeQuent Please NEO \[B-Braun, Germany\])

Interventions

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Percutaneous coronary intervention

1:1 randomization to DES (Ultimaster Tansei) or DCB (Agent \[Boston Scientific, USA\], Prevail \[Medtronic, USA\], or SeQuent Please, SeQuent Please NEO \[B-Braun, Germany\])

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

1. Subject must be at least 19 years of age
2. Subject who is able to understand risks, benefits and treatment alternatives and sign informed consent voluntarily.
3. Patients with at least one lesion with greater than 50% diameter stenosis or fractional flow reserve ≤0.80 requiring revascularization in de-novo coronary artery of reference vessel size ≥2.25 mm
4. Patients with high bleeding risk: one or more of the criteria listed (1) Adjunctive oral anticoagulation treatment planned to continue after PCI (2) Age ≥ 75 years old (3) Baseline Hemoglobin \<11 g/dl (or anemia requiring transfusion during the 4 weeks prior to randomization) (4) Any prior intra-cerebral bleeding (5) Stroke at any time or transient ischemic attack in the previous 6 months. (6) Hospital admission for bleeding during the prior 12 months (7) Non skin cancer diagnosed or treated \< 3 years (8) Planned daily NSAID (other than aspirin) or steroids for \>30 days after PCI (9) Planned surgery that would require interruption of DAPT (within next 12 months) (10) Renal failure defined as calculated creatinine clearance \<40 ml/min or on dialysis (11) Hematological disorders (platelet count \<100,000/mm3 or any coagulation disorder) (12) Severe chronic liver disease defined as patients who have developed any of the following: variceal hemorrhage, ascites, hepatic encephalopathy or jaundice (13) Expected non-compliance to prolonged DAPT for other medical reasons

Exclusion Criteria

1. Patients unable to provide consent
2. Patients with known intolerance to aspirin, P2Y12 inhibitors, or components of drug-eluting stents
3. Patients with angiographic findings of (1) Left main coronary artery disease (2) In-stent restenosis is the cause of target lesion (3) Target lesion in bypass graft (4) True bifurcation lesion that requires upfront 2-stenting
4. Patients who have non-cardiac co-morbid conditions with life expectancy \<2 year
5. Patients who may result in protocol non-compliance (site investigator's medical judgment)
6. Patients with cardiogenic shock or cardiac arrest
7. Patients with severe left ventricular systolic dysfunction (ejection fraction \<30%)
8. Patients with severe valvular heart disease requiring open heart surgery
9. Pregnant or lactating women
Minimum Eligible Age

19 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Seoul St. Mary's Hospital

OTHER

Sponsor Role collaborator

Seoul National University Bundang Hospital

OTHER

Sponsor Role collaborator

Korea University Ansan Hospital

OTHER

Sponsor Role collaborator

Chonnam National University Hospital

OTHER

Sponsor Role collaborator

Chung-Ang University Gwangmyeong Hospital

OTHER

Sponsor Role collaborator

Gangneung Asan Hospital, University of Ulsan College of Medicine

UNKNOWN

Sponsor Role collaborator

Gyeongsang National University Hospital

OTHER

Sponsor Role collaborator

Uijeongbu St. Mary Hospital

OTHER

Sponsor Role collaborator

Keimyung University Dongsan Medical Center

OTHER

Sponsor Role collaborator

Inha University Hospital

OTHER

Sponsor Role collaborator

Chungbuk National University

OTHER

Sponsor Role collaborator

Wonju Severance Christian Hospital

OTHER

Sponsor Role collaborator

SMG-SNU Boramae Medical Center

OTHER

Sponsor Role collaborator

Kangbuk Samsung Hospital, Sungkyunkwan University

OTHER

Sponsor Role collaborator

Ewha Womans University

OTHER

Sponsor Role collaborator

Korea University Guro Hospital

OTHER

Sponsor Role collaborator

Samsung Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Joo Myung Lee

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Joo Myung Lee, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Samsung Medical Center

Locations

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Korea University Ansan Hospital

Ansan, , South Korea

Site Status RECRUITING

Chungbuk National University

Cheongju-si, , South Korea

Site Status RECRUITING

Keimyung University Dongsan Hospital

Daegu, , South Korea

Site Status RECRUITING

Gangneung Asan Hospital, University of Ulsan College of Medicine

Gangneung, , South Korea

Site Status RECRUITING

Chonnam National University Hospital

Gwangju, , South Korea

Site Status RECRUITING

Chung-Ang University Gwangmyeong Hospital

Gwangmyeong, , South Korea

Site Status RECRUITING

Inha University Hospital

Incheon, , South Korea

Site Status RECRUITING

Gyeongsang National University Hospital

Jinju, , South Korea

Site Status RECRUITING

Seoul National University Bundang Hospital

Seongnam-si, , South Korea

Site Status RECRUITING

Ewha Womans University College of Medicine

Seoul, , South Korea

Site Status RECRUITING

Kangbuk Samsung Hospital

Seoul, , South Korea

Site Status RECRUITING

Korea University Kuro Hospital

Seoul, , South Korea

Site Status RECRUITING

Samsung Medical Center

Seoul, , South Korea

Site Status RECRUITING

Seoul National University Boramae Medical Center

Seoul, , South Korea

Site Status RECRUITING

Seoul St. Mary's Hospital, The Catholic University of Korea

Seoul, , South Korea

Site Status RECRUITING

The Catholic University of Korea, Uijeongbu St. Mary's Hospital

Uijeongbu-si, , South Korea

Site Status RECRUITING

Wonju Severance Christian Hospital

Wŏnju, , South Korea

Site Status RECRUITING

Countries

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South Korea

Central Contacts

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Joo Myung Lee, MD, PhD

Role: CONTACT

Phone: 82-2-3410-3391

Email: [email protected]

Min-Jeong Seok

Role: CONTACT

Phone: 82-2-3410-3391

Email: [email protected]

Facility Contacts

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Sunwon Kim, MD, PhD

Role: primary

Jang-Whan Bae, MD, PhD

Role: primary

Hyuck-Jun Yoon, MD, PhD

Role: primary

Hanbit Park, MD, PhD

Role: primary

Young Joon Hong, MD, PhD

Role: primary

Seung Hun Lee, MD, PhD

Role: backup

Sang Yeub Lee, MD, PhD

Role: primary

Sang Don Park, MD, PhD

Role: primary

Hangyul Kim, MD, PhD

Role: primary

Jin-Sin Koh, MD, PhD

Role: backup

Ki-Hyun Jeon, MD, PhD

Role: primary

So-Dam Jung, MD

Role: primary

Jong-Young Lee, MD, PhD

Role: primary

Woochan Kwon, MD

Role: backup

Dong-Oh Kang, MD

Role: primary

Joo Myung Lee, MD, MPH, PhD

Role: primary

David Hong, MD

Role: backup

Hyun Sung Joh, MD

Role: primary

Eun Ho Choo, MD, PhD

Role: primary

Kwan Yong Lee, MD, PhD

Role: backup

Seonghyeon Bu, MD, PhD

Role: primary

Chan Joon Kim, MD, PhD

Role: backup

Sung Gyun Ahn, MD, PhD

Role: primary

Other Identifiers

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DCBHBR2021-12-111-001

Identifier Type: -

Identifier Source: org_study_id