Coronary stenting versus balloon angioplasty in small vessels: a meta-analysis from 11 randomized studies.
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.
Moreno
Raúl
R
Division of Interventional Cardiology, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain. raulmorenog@terra.es
Fernández
Cristina
C
Alfonso
Fernando
F
Hernández
Rosana
R
Pérez-Vizcayno
Maria J
MJ
Escaned
Javier
J
Sabaté
Manel
M
Bañuelos
Camino
C
Angiolillo
Dominick J
DJ
Azcona
Luis
L
Macaya
Carlos
C
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