Drug-Coated Balloon in Anticoagulated and Bleeding Risk Patients Undergoing PCI

Inclusion Criteria:

• Age ≥ 18 years
• Informed written consent
• At least one major or two minor bleeding risk criteria of Academic Research Consortium (ARC) Major Criteria
• Long-term oral anticoagulation
• Severe or end stage chronic kidney disease (CKD) (estimated glomerular - filtrationrate [eGFR] <30 ml/min)
• Hemoglobin <110 g/l
• Spontaneous bleeding requiring hospitalization and transfusion in the past 6 months
• Moderate to severe baseline thrombocytopenia (platelet count <100 x 10e9/L)
• Chronic bleeding diathesis
• Liver cirrhosis with portal hypertension
• Active cancer in the past 12 months
• Previous spontaneous ICH (at any time)
• Previous traumatic ICH within the past 12 months
• Presence of known brain arteriovenous malformation
• Moderate to severe ischemic stroke within the past 6 months
• Nondeferrable major surgery on dual antiplatelet therapy
• Recent major surgery or trauma within 30 days before PCI Minor Criteria
• Age >75 years
• Moderate CKD (eGFR 30-59 ml/min)
• Hemoglobin 110-129 g/l for men and 110-119 g/l for women
• Spontaneous bleeding requiring hospitalization or transfusion within the past 12 -months not meeting major criterion
• Long term use of oral nonsteroidal antiinflammatory drugs or steroids
• Any ischemic stroke at any time not meeting major criterion Either of the following:

1. Stabile angina or dyspnea and a coronary narrowing causing myocardial ischemiadetected in the angiogram. In stable patients prior PCI, the evidence of ischemia isneeded acquired either by perfusion imaging or by pressure wire measurement (FFR)during coronary angiography unless the coronary stenosis is > 90% in diameter.
2. ACS (UAP or NSTEMI): symptoms of heart ischemia≥ 20 minutes and ≥ 0,5mm ST-depressionor transient ST-elevation or T-wave inversion at least in two adjacent leads and/or ahigh sensitivity troponin (hs-tnt) rise at least one unit above the 99. percentil orat least 50% rise in hs-tnt between two samples taken 1-3 hours apart. At least one of the following:

• ≥1 de novo lesions in native coronary arteries or bypass vein grafts
• Reference diameter of the vessel is 2.0-5.0mm'
• Lesion length ≤ 40mm
• Lesion or lesions are suitable for PCI

Exclusion Criteria:

• Inability to give written consent
• STEMI
• Reference diameter of the vessel is <2.0mm or >5.0 mm
• Bifurcation lesion requiring the stenting of either of the branches afterpredilatation (TIMI<3 or significant recoil >30% in the main epicardial vessel: LAD,LCX or RCA) after predilatation)
• Dissection affecting the flow (TIMI<3) or significant recoil (>30% in the mainepicardial vessel: LAD, LCX or RCA) after predilatation
• in-stent restenosis
• Chronic total occlusion
• Life expectancy < 12 months
• Cardiogenic shock at the arrival to the coronary angiography
• Uncertainty about neurological recovery e.g. after resuscitation
• Need for bypass surgery by heart team decision