title: Coronary stenting versus balloon angioplasty in small vessels: a meta-analysis from 11 randomized studies.
abstract: OBJECTIVE
  A meta-analysis of 11 randomized trials was done to compare stenting versus balloon angioplasty (BA) in small coronary vessels.
  
  
  BACKGROUND
  Randomized studies on coronary stenting (CS) in small vessels have yielded controversial results.
  
  
  METHODS
  Eleven randomized trials on CS versus BA in small vessels, including angiographic re-evaluation at six months, were analyzed.
  
  
  RESULTS
  The BeStent (Medtronic Instent, Minneapolis, Minnesota) was used in four studies, the Multi-Link (Guidant, Advanced Cardiovascular Systems Inc., Santa Clara, California) in three trials, and the NIR (Boston Scientific Corp., Boston, Massachusetts), JoStent (Jomed International AB, Helsingborg, Sweden), Tenax (Biotronik, Berlin, Germany), and BioDivysio (Abbott Vascular Devices, Redwood City, California) in the remaining four trials. Overall, 3,541 patients were included (1,672 allocated to BA and 1,869 to stent). The rate of cross-over from balloon to stent in the pooled population was 19%, and unsuccessful stent deployment occurred in 2% of the patients allocated to stent. The pooled rates of restenosis were 25.8% and 34.2% in patients allocated to stent and balloon, respectively (p = 0.003) (risk ratio [RR] 0.77; 95% confidence interval [CI] 0.65 to 0.92). A smaller reference vessel diameter at baseline was associated with a higher risk reduction in the restenosis rate (y = -3.551 + 1.826 [x]; p = 0.012). Patients allocated to stent had lower rates of major adverse cardiac events (15.0% vs. 21.8%, p = 0.002; RR 0.70; 95% CI 0.57 to 0.87) and new target vessel revascularizations (12.5% vs. 17.0%, p = 0.004; RR 0.75, 95% CI 0.61 to 0.91).
  
  
  CONCLUSIONS
  Elective stenting is superior to provisional stenting in small coronary arteries. This benefit is more evident in smaller coronary arteries.
authors.affiliation: Division of Interventional Cardiology, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain. raulmorenog@terra.es
authors.forename: Raúl
authors.initials: R
authors.lastname: Moreno
authors.forename: Cristina
authors.initials: C
authors.lastname: Fernández
authors.forename: Fernando
authors.initials: F
authors.lastname: Alfonso
authors.forename: Rosana
authors.initials: R
authors.lastname: Hernández
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Pérez-Vizcayno
authors.forename: Javier
authors.initials: J
authors.lastname: Escaned
authors.forename: Manel
authors.initials: M
authors.lastname: Sabaté
authors.forename: Camino
authors.initials: C
authors.lastname: Bañuelos
authors.forename: Dominick J
authors.initials: DJ
authors.lastname: Angiolillo
authors.forename: Luis
authors.initials: L
authors.lastname: Azcona
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
mesh_terms: D000800:Angioplasty, Balloon; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology; D018592:Cross-Over Studies; D006801:Humans; D015607:Stents; D016896:Treatment Outcome