Risk of mortality with drug coated balloon use in femoropopliteal disease

Abstract

To the Editor: We read with interest a meta-analysis published in the catheterization and cardiovascular interventions titled––“Drug-coated balloon versus plain old balloon angioplasty in femoropopliteal disease: An updated meta-analysis of randomized controlled trials.” We would like to congratulate the author for this publications. However, we had the following observations to make. The conclusion of the authors pertaining to similar risk of mortality associated with drug coated balloons and plain balloon angioplasty in femoropopliteal disease is undue, when the pooled estimated combined event rates from studies with nonidentical follow periods and relative risk was used for pooled estimation. The conclusion of the authors would have been robust if they had pooled studies with similar follow up period or used time to events measures for their pooled estimation. It is also important here to be noted that the conclusion of the authors are in contrary to a recently published meta-analysis which reported an increased risk of mortality at long term follow up associated with the use of paclitaxelcoated balloons and stents in the femoropopliteal artery of the lower limbs. 2 Hence, the conclusion related to the risk of mortality with drug coated balloon use is to be considered with caution.