Is bare-metal stenting superior to balloon angioplasty for small vessel coronary artery disease? Evidence from a meta-analysis of randomized trials

Pierfrancesco Agostoni, Giuseppe G L Biondi-Zoccai, Gabriele L. Gasparini, Maurizio Anselmi, Giorgio Morando, Marco Turri, Antonio Abbate, Eugene P. McFadden, Corrado Vassanelli, Piero Zardini, Antonio Colombo, Patrick W. Serruys

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: To compare, by meta-analytical techniques, the clinical impact of bare-metal stenting vs. balloon angioplasty for the treatment of lesions in small coronary arteries. Methods and results: We included trials with random allocation and prospective comparison of angioplasty vs. stenting, reference vessel diameter 20%) angioplasty. Thirteen studies (4383 patients) were selected. No differences were found in terms of death and MI, while MACEs, mainly driven by RR, were significantly less common after stenting (17.6%) than after angioplasty (22.7%), OR 0.71 (0.57-0.90). Heterogeneity among trials was present. When considering only optimal angioplasty, MACE rates were homogeneously similar, 17.9 vs. 21.1%, OR 0.86 (0.66-1.11). If angioplasty were suboptimal, MACEs were significantly more common after angioplasty (24%) than after stenting (17.3%), OR 0.62 (0.44-0.88). Conclusion Stenting is superior to balloon angioplasty for the treatment of small vessels, in particular after suboptimal angioplasty. However, MACE and RR rates remain high after stenting, and the advantage of stent over angioplasty is moderate. An optimal balloon angioplasty strategy (with provisional stenting) may achieve results not inferior to routine stenting.

Original languageEnglish
Pages (from-to)881-889
Number of pages9
JournalEuropean Heart Journal
Volume26
Issue number9
DOIs
Publication statusPublished - May 2005

Keywords

  • Balloon angioplasty
  • Meta-analysis
  • Small coronary arteries
  • Stent

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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