Percutaneous Coronary Interventions for the Treatment of Stenoses in Small Coronary Arteries: A Network Meta-Analysis.
This study evaluated the most appropriate percutaneous coronary intervention (PCI) for the treatment of stenoses in small coronary arteries.



PCI in small coronary arteries is associated with an increased risk of lesion failure and restenosis.



Randomized trials comparing different PCI strategies were identified through a broad search of published reports. Primary angiographic outcome was %DS (%DS). A pairwise meta-analysis was performed by using random effects model, followed by a network meta-analysis synthesizing direct and indirect evidence.



Overall, 19 trials were eligible, which included 5,072 patients comprising a network without closed loops among 5 identified interventions (early generation sirolimus-eluting stents [SES], paclitaxel-eluting stents [PES], drug-coated balloons [DCB], bare-metal stents [BMS], and balloon angioplasty [BA]). No dedicated trial was identified evaluating new generation drug-eluting stents. Early generation SES yielded the best angiographic results according to %DS. For %DS, SES was ranked as the most effective treatment, followed by PES (standardized mean differences [SMD]: -0.44; 95% confidence interval [CI]: -0.92 to 0.05 vs. SES) and DCB (SMD: -0.89; 95% CI: -1.53 to -0.25 vs. SES). In terms of absolute differences, SES yielded a reduction of 18% in diameter stenosis compared to DCB. SES significantly reduced the risk of target-lesion revascularization compared to PES (odds ratio [OR]: 0.39; 95% CI: 0.16 to 0.93), DCB (OR: 0.34; 95% CI: 0.10 to 0.97), BMS (OR: 0.21; 95% CI: 0.13 to 0.36), and BA (OR: 0.16; 95% CI: 0.09 to 0.29).



Early generation SES yielded the most favorable angiographic and clinical outcomes for the treatment of stenoses in small coronary arteries. New generation DES need to be evaluated against this standard in future randomized trials.
Department of Cardiology, University Hospital Bern, Bern, Switzerland.
George C M
GC
Siontis
Department of Cardiology, University Hospital Bern, Bern, Switzerland.
Raffaele
R
Piccolo
Department of Cardiology, University Hospital Bern, Bern, Switzerland.
Fabien
F
Praz
Department of Cardiology, University Hospital Bern, Bern, Switzerland.
Marco
M
Valgimigli
Department of Cardiology, University Hospital Bern, Bern, Switzerland.
Lorenz
L
Räber
Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
Dimitris
D
Mavridis
Institute of Primary Health Care and Clinical Trials Unit, University of Bern, Bern, Switzerland.
Peter
P
Jüni
Department of Cardiology, University Hospital Bern, Bern, Switzerland. Electronic address: stephan.windecker@insel.ch.
Stephan
S
Windecker
D000368:Aged; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D054855:Drug-Eluting Stents; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation; D011474:Prosthesis Design; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome
coronary disease; drug-coating balloon(s); drug-eluting stent(s); network meta-analysis; small coronary arteries