Year in Review: DCBs Big in Coronary News, Along With Beta-blockers in STEMI

Advances in the treatment of coronary artery disease remained steady in 2025, as in recent years, but the past 12 months also brought developments in novel areas, such as drug-coated balloons (DCBs), that have many clinicians excited for potential shifts in care.

Lorenz Räber, MD, PhD (Bern University Hospital, Inselspital, Switzerland), who spoke with TCTMD about his top coronary news of the year, called SELUTION a “hallmark” trial, adding that he is cautiously optimistic about the future.

“The chapter is not closed, [but SELUTION] supports a modest use,” said Räber.

Allen Jeremias, MD (St. Francis Hospital, Roslyn, NY), is also “bullish” on the future of DCBs based on the SELUTION data presented at TCT 2025. One “crazy” aspect of that trial, said Jeremias, was that researchers randomized more than 1,600 patients to the sirolimus-eluting balloon (Selution; Cordis) or a DES without doing a substantial pilot study first.

Some additional DCB data came in March from AGENT IDE, which continued to show a benefit with the Agent DCB (Boston Scientific) compared with balloon angioplasty at 2 years. Also, an AGENT IDE subanalysis from August confirmed the device works well in patients with in-stent restenosis. Notably, though, not all DCB data were a slam dunk, with findings from REC-CAGEFREE I showing that DES are still safer in de novo lesions.

Outside of DCBs, another major coronary trial from earlier this year was FAVOR III Europe, according to Jeremias. The study supported fractional flow reserve (FFR) over quantitative flow ratio (QFR) to drive revascularization decisions. “It highlights that there might be also differences among the angio FFR systems—that not all are the same and we have to look at them individually,” he said.

Other coronary imaging studies making headlines included extended FLAVOUR follow-up that showed long-term noninferiority of using FFR compared with IVUS to guide PCI in intermediate lesions. Optical coherence tomography made waves as well, besting angiography in ACS patients in an OCCUPI subanalysis.

For Räber, a “hot topic” in 2025 was the use of beta-blockers after STEMI. An analysis of the ABYSS trial presented at EuroPCR reported rises in both BP and heart rate when patients with MI and preserved left ventricular ejection fraction stop taking beta-blockers. Two trials presented at the European Society of Cariology Congress supported the use of beta-blockers in post-MI patients with mildly reduced EF (40-49%), while a meta-analysis presented at the American Heart Association Scientific Sessions confirmed that these drugs aren’t helpful in those with preserved EF.

As in prior years, there were multiple studies published pertaining to the refinement of antiplatelet therapy following PCI, especially for ACS, Räber highlighted.

The year started with a commentary arguing in favor of writing practice guidelines that prioritize ischemic and bleeding risks when considering antiplatelet therapy. Three-year results from HOST-IDEA confirmed that only a short course of dual antiplatelet therapy (DAPT) is needed when patients receive contemporary DES, and an analysis of MASTER DAPT showed the success of short DAPT in patients at high risk for bleeding. Also, a meta-analysis indicated that sex plays a role in the success of de-escalation strategies. Following ACS, opting for a P2Y12 seems better than aspirin if going the monotherapy route, according to one meta-analysis, and the 4-D ACS trial showed no increased ischemic risk of short DAPT. TACSI and TOP-CABG both looked at DAPT following coronary artery bypass grafting.

The PROCTOR trial, presented at TCT, offered an interesting look at the best course of action for patients with failed saphenous vein grafts after CABG—PCI to open the graft seems to be it, at least compared with intervening on the bypassed native coronary artery.

Ways to Improve

Several STEMI studies dove into the different ways in which the field might improve. For one, 10-year follow-up from DANAMI-3-PRIMULTI showed that FFR-guided complete revascularization is the way to go compared with treating just the culprit lesion. Registry data linked worse PCI outcomes to delays in STEMI treatment, which remain prevalent across the country. Also, administering the novel injectable glycoprotein IIb/IIIa inhibitor zalunfiban (Disaggpro; CeleCor Therapeutics) before hospital admission for STEMI saw a win in the CELEBRATE trial.

As for STEMI-related shock, a retrospective analysis identified vast disparities in use of mechanical circulatory support across the United States, and data from DanGer Shock suggested that immediate multivessel PCI could be the best option.

Two studies looking at chronic total occlusions (CTOs) may be shifting practice to a two-step intervention, at least for the most complex lesions. First, the nonrandomized INVEST-CTO study, presented at TCT, showed that staged PCI could enhance safety. Next, the STAR trial demonstrated that in patients undergoing bailout PCI, subintimal tracking and reentry (STAR) is associated with good technical success, even when the second procedure is performed 2 months later.

Other highlights from 2025 included 5-year data from FAME 3 showing similar outcomes with FFR-guided PCI and CABG. Coronary specialists were also pleased to receive new American guidelines on the management of ACS in February.

The quest to optimally treat ischemia with nonobstructive coronary arteries (INOCA) was stymied with new data from the women-only WARRIOR trial indicating that intensive medical therapy doesn’t seem to help, but data from PROMISE showed that a targeted treatment strategy seems to reduce angina symptoms in patients with suspected myocardial infarction with nonobstructive coronary arteries (MINOCA). Also, data from VESALIUS-CV are the first to show that evolocumab can lower the risk of MACE among patients without a history of MI or stroke.

Finally, the field mourned master CTO operator Dimitrios Karmpaliotis, MD, PhD, who died in June.