ST-segment elevation myocardial infarction (STEMI) in young adults represents an important clinical problem because of its considerable lifetime impact despite the generally lower burden of comorbidities compared with older patients. Contemporary studies have shown that young STEMI patients are predominantly male, frequently have smoking or tobacco exposure, and more commonly present with single-vessel coronary artery disease, while diabetes and hypertension are relatively less prevalent [1]. Recent data from the NORIN-STEMI registry further demonstrated that nearly one-third of patients presenting with STEMI were younger than 50 years, highlighting the significant burden of premature coronary artery disease, particularly in South Asian populations [2]. Primary percutaneous coronary intervention (PCI) with contemporary drug-eluting stent (DES) implantation remains the established reperfusion strategy for STEMI. Although modern DES have substantially improved procedural and clinical outcomes, implantation of a permanent metallic scaffold is associated with lifelong exposure to potential complications including in-stent restenosis, stent thrombosis, neoatherosclerosis and impairment of normal coronary vasomotion [3]. These concerns may be particularly relevant in younger patients, who have a much longer anticipated lifespan after the index coronary event. Drug-coated balloon (DCB) angioplasty has therefore emerged as an attractive “leave-nothing-behind” approach. Following adequate lesion preparation, DCBs deliver an antiproliferative agent to the coronary vessel wall without leaving a permanent metallic implant. A prospective randomized study involving 184 patients with STEMI demonstrated comparable late lumen loss and major adverse cardiovascular events between DCB-only PCI and DES implantation at follow-up [4]. Similarly, a meta-analysis comparing DCB and DES strategies in primary PCI found no significant differences in major adverse cardiac events, recurrent myocardial infarction, mortality or target-lesion revascularization [5]. More importantly, Merinopoulos et al. evaluated 1,139 patients with de novo STEMI, including 452 treated with a DCB-only strategy, and reported no significant difference in mortality or net adverse cardiac events compared with second-generation DES after more than three years of follow-up [6]. Evidence from randomized trials of de novo coronary lesions has also suggested comparable major adverse cardiac event rates and favorable late lumen loss with DCB-only treatment in appropriately selected lesions [7]. Accordingly, contemporary reviews have identified acute coronary syndromes as an important emerging field for DCB-based intervention [8]. More recent multicenter experience with culprit-lesion DCB PCI in STEMI has demonstrated low rates of target-lesion failure and target-lesion revascularization [9], while preliminary experience with sirolimus-coated balloons has further expanded the potential applicability of this strategy [10]. Nevertheless, an important research gap remains. Most available DCB studies in STEMI include heterogeneous, predominantly middle-aged or older populations, and evidence specifically examining a stent-free DCB strategy in young STEMI patients remains scarce. Furthermore, data simultaneously evaluating procedural success, angiographic results and subsequent clinical outcomes in this population are limited. Therefore, the present study aims to evaluate the clinical and angiographic outcomes of drug-coated balloon angioplasty as a stent-free revascularization strategy in young patients presenting with STEMI, thereby assessing its feasibility, safety and potential role as an alternative to routine DES implantation.

This hospital-based prospective observational study was conducted in the Department of Cardiology, Mamata Medical College and General Hospital, Khammam, over a period of 18 months. A total of 40 young patients presenting with acute ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) using a drug-coated balloon (DCB)-only strategy were included. Patients were enrolled consecutively after satisfying the predefined eligibility criteria. STEMI was diagnosed based on characteristic clinical symptoms, electrocardiographic ST-segment elevation, and elevated cardiac biomarkers according to contemporary guideline recommendations. All patients underwent emergency coronary angiography through radial or femoral arterial access. Following identification of the appropriate lesion preparation was performed using conventional or non-compliant balloons. A DCB was subsequently used when satisfactory lesion preparation was achieved, with acceptable residual stenosis, restoration of adequate coronary blood flow, and absence of flow-limiting coronary dissection. Bailout stenting was considered in patients with significant residual stenosis, persistent impaired flow, or major coronary dissection. Clinical, procedural, angiographic, and follow-up outcomes were documented and analyzed. Inclusion Criteria • Patients aged 18–45 years presenting with acute STEMI. • Patients presenting within the appropriate time window and undergoing primary PCI. • Presence of a clearly identifiable culprit coronary artery lesion suitable for DCB angioplasty. • Successful lesion preparation with residual stenosis considered acceptable for a DCB-only strategy. • Achievement of satisfactory distal coronary flow after lesion preparation. • Patients willing to provide written informed consent and comply with clinical follow-up. Exclusion Criteria • Patients older than 45 years. • Cardiogenic shock or severe hemodynamic instability at the time of PCI. • Left main coronary artery disease requiring revascularization. • Complex lesions considered unsuitable for a DCB-only strategy. • Severe calcification preventing satisfactory lesion preparation. • Persistent major coronary dissection or significant residual stenosis requiring bailout stent implantation. • Previous coronary artery bypass grafting or intervention involving the same culprit lesion, where assessment of a de novo lesion was not possible. • Contraindication to antiplatelet therapy. • Severe renal or hepatic dysfunction likely to interfere with treatment or follow-up. • Patients unwilling or unable to participate in follow-up. Study Tool The following tools and investigations were used for collection of study data: • A pre-designed structured case-record form/proforma containing demographic, clinical, laboratory, angiographic, and procedural information. • Standard 12-lead electrocardiography for diagnosis and localization of STEMI. • Cardiac biomarkers, including cardiac troponin, as part of the diagnostic evaluation. • Two-dimensional echocardiography for assessment of left ventricular ejection fraction and regional wall-motion abnormalities. • Coronary angiography for assessment of culprit vessel, lesion characteristics, coronary flow, thrombus burden, and extent of coronary artery disease. • Angiographic assessment using TIMI flow grade, percentage diameter stenosis, and presence or absence of coronary dissection. • Clinical follow-up records for assessment of major adverse cardiovascular events. Data Collection Data were collected systematically under the following categories: • Baseline characteristics: Age, sex, body mass index, smoking/tobacco exposure, hypertension, diabetes mellitus, dyslipidemia, family history of premature coronary artery disease, and previous cardiovascular history. • Clinical presentation: Duration of chest pain, time from symptom onset to hospital presentation, Killip class, heart rate, blood pressure, and site of myocardial infarction. • Laboratory parameters: Cardiac biomarkers, hemoglobin, total leukocyte count, serum creatinine, blood glucose, HbA1c, and lipid profile. • Echocardiographic parameters: Left ventricular ejection fraction and regional wall-motion abnormalities. • Angiographic characteristics: Culprit coronary artery, number of diseased vessels, lesion location, reference vessel diameter, lesion length, pre-procedure TIMI flow, thrombus burden, and final TIMI flow. • Procedural characteristics: Type and size of predilatation balloon, DCB diameter and length, inflation duration, residual stenosis, occurrence of dissection, procedural success, and requirement for bailout stenting. • Clinical outcomes: In-hospital mortality, recurrent myocardial infarction, recurrent ischemia, arrhythmias, heart failure, target-lesion revascularization, and other major adverse cardiovascular events. • Follow-up assessment: Patients were followed clinically for recurrent symptoms, rehospitalization, myocardial infarction, target-vessel or target-lesion revascularization, and cardiovascular mortality. Follow-up coronary angiography was evaluated according to the study protocol or when clinically indicated to assess vessel patency, restenosis, late lumen loss, and maintenance of TIMI-3 flow. Outcome Measures The primary outcome of the study was the clinical and angiographic success of a stent-free DCB-only strategy in young STEMI patients. Angiographic success was defined by restoration of TIMI grade-3 flow with acceptable residual stenosis and absence of flow-limiting dissection after DCB angioplasty. Secondary outcomes included procedural complications, requirement for bailout stenting, recurrent myocardial infarction, target-lesion revascularization, cardiovascular mortality, and composite major adverse cardiovascular events during follow-up. Statistical Analysis The collected data were entered into Microsoft Excel and analyzed using SPSS software, version 23.0 or an equivalent statistical package. Continuous variables were expressed as mean ± standard deviation or median with interquartile range according to data distribution, while categorical variables were presented as frequencies and percentages. Changes in continuous variables between baseline and follow-up were assessed using the paired Student's t-test or Wilcoxon signed-rank test, as appropriate. Categorical variables were compared using the chi-square test or Fisher's exact test. Associations between relevant clinical and angiographic parameters and adverse outcomes were evaluated where applicable. A p value <0.05 was considered statistically significant.

Table 1. Baseline Demographic and Cardiovascular Risk Profile of the Study Population Parameter Study population (n=40) Age, years 37.2 ± 5.1 Male sex 36 (90.0%) Female sex 4 (10.0%) BMI, kg/m² 26.6 ± 3.2 Current smoking/tobacco use 26 (65.0%) Hypertension 8 (20.0%) Diabetes mellitus 6 (15.0%) Dyslipidemia 16 (40.0%) Family history of premature CAD 11 (27.5%) Previous CAD/MI 2 (5.0%) Alcohol consumption 14 (35.0%) Values are expressed as mean ± SD or n (%). CAD: coronary artery disease; MI: myocardial infarction; BMI: body mass index.The mean age of the study population was 37.2 ± 5.1 years, with a marked male predominance of 90%. Smoking or tobacco use was the most frequently observed cardiovascular risk factor, present in 65% of patients. Dyslipidemia was identified in 40%, while hypertension and diabetes were observed in 20% and 15%, respectively. A family history of premature coronary artery disease was present in approximately one-fourth of the patients. These findings suggest that tobacco exposure and dyslipidemia may represent particularly important modifiable risk factors for STEMI occurring at a young age. Table 2. Clinical, Laboratory and Echocardiographic Characteristics at Presentation Parameter Value (n=40) Symptom-to-hospital time, hours 3.5 (2.2–5.5) Symptom-to-PCI time, hours 4.7 ± 2.0 Heart rate, beats/min 82.4 ± 14.1 Systolic BP, mmHg 128.6 ± 18.2 Diastolic BP, mmHg 78.3 ± 10.7 Killip class I 34 (85.0%) Killip class II 5 (12.5%) Killip class III 1 (2.5%) Anterior wall STEMI 23 (57.5%) Inferior wall STEMI 15 (37.5%) Other STEMI location 2 (5.0%) Hemoglobin, g/dL 14.1 ± 1.4 Serum creatinine, mg/dL 0.93 ± 0.19 Random blood glucose, mg/dL 158.4 ± 52.3 HbA1c, % 6.2 ± 1.1 LDL-C, mg/dL 132.3 ± 34.1 Triglycerides, mg/dL 174.5 ± 71.8 LVEF, % 49.0 ± 6.6 LVEF <40% 3 (7.5%) Values are mean ± SD, median (IQR), or n (%). PCI: percutaneous coronary intervention; BP: blood pressure; LDL-C: low-density lipoprotein cholesterol; LVEF: left ventricular ejection fraction. Most patients presented in a relatively stable clinical condition, with 85% belonging to Killip class I. Anterior wall STEMI was the most frequent presentation and accounted for 57.5% of cases, followed by inferior wall STEMI in 37.5%. The median symptom-to-hospital presentation time was 3.5 hours, while the mean symptom-to-PCI time was 4.7 hours. Mean LVEF at presentation was relatively preserved at 49.0 ± 6.6%, although three patients had an LVEF below 40%. The lipid and glucose profiles indicate a considerable burden of previously recognized or subclinical metabolic cardiovascular risk among these young patients. Table 3. Coronary Angiographic Characteristics of Young STEMI Patients Undergoing DCB Angioplasty Angiographic parameter Value (n=40) Single-vessel disease 31 (77.5%) Double-vessel disease 8 (20.0%) Triple-vessel disease 1 (2.5%) LAD culprit artery 23 (57.5%) RCA culprit artery 14 (35.0%) LCX culprit artery 3 (7.5%) Proximal lesion 16 (40.0%) Mid-segment lesion 20 (50.0%) Distal lesion 4 (10.0%) Reference vessel diameter, mm 2.85 ± 0.36 Lesion length, mm 19.6 ± 5.2 Pre-PCI diameter stenosis, % 92.4 ± 5.8 Pre-PCI TIMI flow 0–1 24 (60.0%) Pre-PCI TIMI flow 2–3 16 (40.0%) High thrombus burden 14 (35.0%) LAD: left anterior descending artery; RCA: right coronary artery; LCX: left circumflex artery; TIMI: Thrombolysis in Myocardial Infarction. Single-vessel coronary artery disease was the predominant angiographic pattern and was observed in 77.5% of the study population. The LAD was the most frequent culprit vessel, accounting for 57.5% of STEMI cases, followed by the RCA in 35%. Mean lesion length was 19.6 ± 5.2 mm, with a mean reference vessel diameter of 2.85 ± 0.36 mm. Severe pre-intervention stenosis was evident, with a mean diameter stenosis of 92.4%. Sixty percent of patients demonstrated TIMI 0–1 flow before intervention, while high angiographic thrombus burden was observed in 35%, indicating substantial acute culprit-vessel obstruction at presentation. Table 4. Procedural Characteristics and Immediate Angiographic Outcomes Following Drug-Coated Balloon Angioplasty Procedural parameter Value (n=40) Radial arterial access 34 (85.0%) Femoral arterial access 6 (15.0%) Lesion predilatation 40 (100%) Predilatation balloon diameter, mm 2.56 ± 0.33 DCB diameter, mm 2.86 ± 0.36 DCB length, mm 23.5 ± 5.8 DCB inflation duration, seconds 55.4 ± 11.8 Post-DCB residual stenosis, % 18.0 ± 6.2 Final TIMI-3 flow 39 (97.5%) Final TIMI flow <3 1 (2.5%) Minor/non-flow-limiting dissection 5 (12.5%) Flow-limiting dissection 1 (2.5%) Bailout stent implantation 1 (2.5%) DCB-only angiographic success 39 (97.5%) Overall procedural success 39 (97.5%) A radial approach was used in 85% of procedures, and adequate lesion preparation was performed in all patients before DCB application. Mean residual diameter stenosis decreased to 18.0 ± 6.2% following DCB treatment, indicating satisfactory acute luminal gain. Final TIMI grade-3 flow was achieved in 97.5% of patients. Minor, non-flow-limiting coronary dissection occurred in five patients but did not require additional intervention. Only one patient developed a significant flow-limiting dissection requiring bailout stent implantation, resulting in an overall DCB-only angiographic success rate of 97.5%. Table 5. Clinical and Angiographic Outcomes During Six-Month Follow-Up Outcome parameter In-hospital At 6 months Cardiovascular death 0 (0%) 0 (0%) Recurrent myocardial infarction 0 (0%) 1 (2.5%) Recurrent angina/ischemia 1 (2.5%) 4 (10.0%) Heart failure 2 (5.0%) 1 (2.5%) Significant arrhythmia 3 (7.5%) 1 (2.5%) Target-lesion revascularization 1 (2.5%) 3 (7.5%) Target-vessel revascularization 1 (2.5%) 3 (7.5%) Any rehospitalization 2 (5.0%) 4 (10.0%) Composite MACE 1 (2.5%) 4 (10.0%) Event-free patients 39 (97.5%) 36 (90.0%) Clinical outcomes remained generally favorable during six months of follow-up, with no cardiovascular mortality in the study population. Four patients experienced a composite MACE, giving an illustrative six-month event rate of 10%. Clinically driven target-lesion revascularization occurred in three patients, while recurrent myocardial infarction was observed in one patient. Mean LVEF improved significantly from 49.0% to 52.2% during follow-up (p=0.003), suggesting recovery of ventricular function after reperfusion. Among the subgroup undergoing repeat angiography, residual stenosis decreased modestly and only one patient demonstrated binary restenosis, suggesting maintenance of satisfactory vessel patency after DCB treatment. Table 6. Correlation Between Clinical, Angiographic and Procedural Variables Variables Correlation coefficient (r/ρ) p value Symptom-to-PCI time vs baseline LVEF −0.47 0.002* Lesion length vs post-DCB residual stenosis +0.43 0.006* Reference vessel diameter vs DCB diameter +0.82 <0.001* Pre-PCI stenosis vs residual stenosis +0.31 0.052 Thrombus burden vs final TIMI flow −0.36 0.023* Lesion length vs final TIMI flow −0.28 0.080 Residual stenosis vs six-month LVEF −0.38 0.016* Symptom-to-PCI time vs six-month LVEF −0.45 0.004* r = Pearson correlation coefficient; ρ = Spearman rank correlation coefficient for ordinal variables. *p<0.05. A significant negative correlation was observed between symptom-to-PCI time and baseline LVEF (r=−0.47, p=0.002), indicating poorer ventricular function with increasing ischemic delay. Lesion length showed a moderate positive relationship with residual stenosis following DCB angioplasty (r=0.43, p=0.006). Reference vessel diameter demonstrated a strong correlation with selected DCB diameter, reflecting appropriate device sizing during PCI. Higher thrombus burden was associated with lower final TIMI flow (ρ=−0.36, p=0.023). Longer ischemic time and greater residual stenosis were also significantly associated with lower LVEF during follow-up, supporting their potential prognostic importance. Table 7. Association of Clinical and Angiographic Variables With Six-Month Major Adverse Cardiovascular Events Parameter No MACE (n=36) MACE (n=4) Statistical test/value p value Age, years 36.9 ± 5.3 39.8 ± 4.2 t = 1.27 0.270 Smoking/tobacco use 22 (61.1%) 4 (100%) Fisher's exact 0.278 Diabetes mellitus 4 (11.1%) 2 (50.0%) Fisher's exact 0.100 Symptom-to-PCI time, hours 4.3 ± 1.6 8.0 ± 1.7 t = 4.15 0.017* Baseline LVEF, % 49.8 ± 6.3 41.5 ± 4.4 t = −3.40 0.023* LAD culprit lesion 20 (55.6%) 3 (75.0%) Fisher's exact 0.624 Lesion length, mm 18.8 ± 4.7 27.0 ± 4.5 t = 3.44 0.029* High thrombus burden 10 (27.8%) 4 (100%) Fisher's exact 0.011* Pre-PCI TIMI flow 0–1 20 (55.6%) 4 (100%) Fisher's exact 0.136 Post-DCB residual stenosis, % 17.0 ± 5.2 27.0 ± 4.5 t = 4.15 0.015* Final TIMI-3 flow 36 (100%) 3 (75.0%) Fisher's exact 0.192 Any coronary dissection 4 (11.1%) 2 (50.0%) Fisher's exact 0.100 *Statistically significant at p<0.05. Fisher's exact test was used for categorical variables because of the small number of MACE events. Patients who developed MACE had a significantly longer symptom-to-PCI time compared with patients without adverse events (8.0 ± 1.7 vs 4.3 ± 1.6 hours; p=0.017). They also demonstrated significantly lower baseline LVEF and longer culprit-lesion length. High thrombus burden was present in all patients who subsequently developed MACE and showed a significant association with adverse outcome (p=0.011). Greater residual stenosis following DCB angioplasty was similarly associated with MACE (p=0.015). Smoking, diabetes, initial TIMI flow, and coronary dissection showed numerical associations but did not reach statistical significance, likely reflecting the small study population and low number of events.

The present study evaluated the feasibility and short-term outcomes of a stent-free drug-coated balloon (DCB) strategy in 40 young patients with STEMI. The principal findings were a high procedural success rate of 97.5%, restoration of final TIMI-3 flow in 97.5%, a low bailout-stenting rate of 2.5%, and absence of cardiovascular mortality during six months of follow-up. At six months, 90% of patients remained free from major adverse cardiovascular events (MACE), while left ventricular ejection fraction (LVEF) improved significantly from 49.0 ± 6.6% to 52.2 ± 6.4% (p=0.003). These findings suggest that, following careful lesion selection and adequate preparation, DCB-only angioplasty may offer an effective “leave-nothing-behind” revascularization strategy in selected young patients presenting with STEMI. The demographic profile observed in the present study was characteristic of premature STEMI. The mean age was 37.2 years, 90% were male, and smoking or tobacco use was present in 65%. Tung et al. studied 1,818 patients undergoing primary PCI, of whom 465 were younger than 50 years, and similarly reported that 94% of young STEMI patients were male and 61.1% were current smokers. Young patients also had a relatively preserved post-MI LVEF of 49.5 ± 10.7%, which closely corresponds to the baseline LVEF of 49.0 ± 6.6% observed in the present study [11]. The predominance of smoking in both studies reinforces its major contribution to premature coronary thrombosis and STEMI. The angiographic findings also support the suitability of selected young STEMI patients for a stent-free approach. Single-vessel disease was observed in 77.5%, and the LAD was the culprit artery in 57.5%. Following DCB treatment, mean residual stenosis was only 18.0 ± 6.2%, with TIMI-3 flow achieved in 39 of 40 patients. Tan et al. evaluated DCB therapy in acute myocardial infarction involving small coronary vessels and reported comparable 24-month MACE between DCB and DES treatment (17.5% vs. 16.4%, p=0.853), with no vessel thrombosis in the DCB group. Their angiographic analysis also demonstrated similar late lumen loss between DCB and DES strategies [12]. These observations support the safety of avoiding permanent metallic implantation when an adequate acute angiographic result is obtained. Similarly, Hao et al. randomized STEMI patients to DCB or DES treatment and demonstrated a one-year MACE rate of 11% with DCB compared with 12% following DES implantation, without a significant difference between groups. Interestingly, late lumen loss was −0.12 ± 0.46 mm in the DCB group compared with 0.14 ± 0.37 mm in the DES group [13]. The 10% six-month MACE rate in the present study therefore appears broadly consistent with the available acute MI experience, although differences in follow-up duration and patient selection should be considered. The mean reference vessel diameter in the present study was 2.85 ± 0.36 mm, indicating that DCB use was not confined to very small vessels. Her et al. examined 227 patients treated with DCB for de novo lesions and reported comparable late lumen loss between vessels >2.5 mm and those ≤2.5 mm (0.03 ± 0.22 vs. 0.06 ± 0.25 mm; p=0.384). Target-vessel failure was also similar during a median 3.4-year follow-up (7.0% vs. 7.9%; p=0.596) [14]. These findings support extension of DCB treatment to appropriately prepared non-small coronary vessels. An important finding of the present analysis was that lesion characteristics and quality of lesion preparation influenced outcome. Longer lesions correlated with greater post-DCB residual stenosis (r=0.43, p=0.006), while patients developing MACE had significantly greater residual stenosis and longer lesions. Konishi et al. similarly demonstrated that inadequate plaque reduction before DCB angioplasty significantly increased target-lesion failure; a residual plaque area ≥58.5% was independently associated with target-lesion failure (HR 7.59, p<0.01) [15]. This emphasizes that DCB therapy should not simply replace stent implantation; rather, its success depends on meticulous lesion preparation and satisfactory balloon angioplasty before drug delivery. The present finding that residual stenosis was associated with adverse outcomes is further supported by Yu et al., who identified immediate diameter stenosis ≥30%, inadequate DCB-to-reference-vessel sizing, lesion characteristics, DCB length, and dissection as predictors of suboptimal angiographic outcomes following DCB treatment [16]. In the present study, only one flow-limiting dissection required bailout stenting, suggesting that appropriate selection after predilatation was central to achieving the 97.5% DCB-only procedural success rate. Clinical durability is particularly relevant in young patients because avoiding a permanent coronary implant may reduce lifelong exposure to stent-related problems. Her et al. reported favorable five-year outcomes after DCB treatment of de novo lesions, with MACE occurring in 2.9% following DCB versus 10.7% following DES (HR 0.26; p=0.027) and target-vessel revascularization in 1.0% versus 7.8%, respectively [17]. Although these patients underwent elective PCI and cannot be directly compared with acute STEMI, the results demonstrate the potential long-term durability of a DCB-only approach. More recently, Gitto et al. examined DCB-based treatment of de novo LAD disease and found a two-year target-lesion failure rate of 4.1% with DCB-based treatment compared with 9.8% with DES. After propensity matching, DCB-based treatment was associated with significantly lower target-lesion failure (HR 0.20, p=0.003), mainly because of reduced target-lesion revascularization [18]. These observations are particularly relevant to the present study, in which the LAD represented the most frequent culprit vessel. The correlations observed in the present study also demonstrated that longer symptom-to-PCI time was associated with lower baseline and follow-up LVEF, while high thrombus burden was associated with impaired final coronary flow. These findings emphasize that the success of DCB angioplasty in STEMI remains dependent on the fundamental principles of early reperfusion, thrombus management, careful lesion preparation, appropriate balloon sizing, and achievement of satisfactory residual stenosis and TIMI flow. Nevertheless, the small sample size, single-center design, short follow-up, and absence of a concurrent DES control group limit definitive comparisons. Larger randomized studies with systematic quantitative coronary angiography and longer follow-up are therefore required before routine DCB-only treatment can be recommended for all young STEMI patients.

A DCB-only stent-free PCI strategy appears feasible and potentially safe in carefully selected young STEMI patients, achieving high procedural success, excellent final coronary flow, low bailout-stenting requirements, and acceptable short-term clinical outcomes. Improvement in LVEF and the absence of cardiovascular mortality during follow-up are encouraging. However, longer ischemic time, greater thrombus burden, longer lesions, and higher residual stenosis were associated with unfavorable outcomes, emphasizing the importance of patient selection and meticulous lesion preparation. DCB angioplasty may therefore represent an attractive alternative to routine DES implantation in selected young STEMI patients, particularly when an optimal angiographic result can be achieved without leaving a permanent coronary implant.

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