TY - JOUR
T1 - Is bare-metal stenting superior to balloon angioplasty for small vessel coronary artery disease? Evidence from a meta-analysis of randomized trials
AU - Agostoni, Pierfrancesco
AU - Biondi-Zoccai, Giuseppe G L
AU - Gasparini, Gabriele L.
AU - Anselmi, Maurizio
AU - Morando, Giorgio
AU - Turri, Marco
AU - Abbate, Antonio
AU - McFadden, Eugene P.
AU - Vassanelli, Corrado
AU - Zardini, Piero
AU - Colombo, Antonio
AU - Serruys, Patrick W.
PY - 2005/5
Y1 - 2005/5
N2 - 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.
AB - 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.
KW - Balloon angioplasty
KW - Meta-analysis
KW - Small coronary arteries
KW - Stent
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U2 - 10.1093/eurheartj/ehi116
DO - 10.1093/eurheartj/ehi116
M3 - Article
C2 - 15681573
AN - SCOPUS:21044442668
VL - 26
SP - 881
EP - 889
JO - European Heart Journal
JF - European Heart Journal
SN - 0195-668X
IS - 9
ER -