Small coronary vessel angioplasty: outcomes and technical considerations

Figures & data

Table 1 Comparison of angiographic characteristics, death, MI, TLR, and MACEs, following BMS and balloon angioplasty

Study	Total No. of patients	RVD (mm)	BMS vs balloon angioplasty
			Death (%) OR (95% CI)	MI (%) OR (95% CI)	TLR (%) OR (95% CI)	MACE (%) OR (95% CI)
Park et al^Citation12	120	<3.0	0.0 vs 0.0 NA	1.6 vs 3.2 0.49 (0.04–5.57)	3.3 vs 5.0 0.66 (0.11–4.07)	5.0 vs 8.3 0.58 (0.13–2.54)
ISAR-SMART^Citation11	404	2.0–2.8	0.9 vs 1.5 0.66 (0.11–3.93)	3.4 vs 3.0 1.15 (0.38–3.48)	20.1 vs 16.5 1.27 (0.77–2.11)	23.0 vs 19.5 1.28 (0.79–2.06)
BESMART^Citation13	381	<3.0	0.52 vs 2.1 0.24 (0.03–2.19)	4.6 vs 5.8 0.80 (0.32–1.97)	13.5 vs 23.8 0.50 (0.29–0.85)	17.1 vs 29.6 0.49 (0.30–0.80)
SISA^Citation19	351	2.3–2.9	0.6 vs 0.5 1.08 (0.07–17.36)	4.1 vs 9.8 0.39 (0.16–0.97)	20.7 vs 24.7 0.80 (0.48–1.31)	20.7 vs 25.2 0.77 (0.47–1.27)
SISCA^Citation14	145	2.1–3.0	1.3 vs 1.4, 0.96 (0.06–15.63)	2.7 vs 1.4 1.94 (0.17–21.93)	9.4 vs 22.5 0.36 (0.14–0.94)	9.4 vs 23.9 0.33 (0.13–0.86)
COAST^Citation20	588	2.0–2.6	1.0 vs 0.0 4.52 (0.24–84.33)	0.5 vs 1.0 0.49 (0.07–3.53)	10.6 vs 14.3 0.71 (0.43–1.19)	11.7 vs 15.3 0.73 (0.44–1.20)
Kinsara et al^Citation21	202	<2.5	1.0 vs 0.0 3.35 (0.13–83.11)	6.2 vs 6.6 0.94 (0.31–2.91)	12.5 vs 23.5 0.64 (0.45–0.92)	19.7 vs 30.1 0.57 (0.30–1.09)
SVS^Citation22	496	2.0–3.0	2.4 vs 2.4 0.98 (0.31–3.09)	4.8 vs 3.6 1.33 (0.55–3.21)	18.8 vs 14.2 1.40 (0.97–2.25)	23.2 vs 18.6 1.31 (0.85–2.03)
RAP^Citation23	426	2.2–2.7	0.47 vs 1.4 0.33 (0.3–3.23)	0.9 vs 1.4 0.67 (0.11–4.06)	12.2 vs 22.4 0.48 (0.29–0.91)	13.6 vs 25.2 0.47 (0.29–0.77)
CHIVAS^Citation24	302	<3.0	0 vs 2.5 0.11 (0.01–2.11)	0 vs 0.6 0.34 (0.01–8.53)	10.8 vs 14.9 0.69 (0.35–1.37)	10.8 vs 18.1 0.55 (0.28–1.06)
ISAR-SMART II^Citation25	502	<2.5	3.9 vs 3.6 1.10 (0.44–2.75)	3.9 vs 4.0 0.98 (0.40–2.91)	20.1 vs 20.5 0.98 (0.63–1.51)	26.8 vs 26.9 1.0 (0.67–1.48)
LASMAL^Citation26	246	2.0–2.9	0.8 vs 3.27 0.24 (0.03–2.18)	5.6 vs 9.0 0.60 (0.22–1.61)	15.3 vs 20.4 0.70 (0.36–1.35)	16.9 vs 27.8 0.53 (0.29–0.97)
LASMAL II^Citation27	220	2.0–2.9	1.8 vs 1.8, 0.98 (0.14–7.10)	6.3 vs 7.3 0.85 (0.30–2.43)	15.3 vs 14.6 1.05 (0.50–2.20)	18.0 vs 22.0 0.78 (0.40–1.51)
Total	4,383	<3.0	1.3 vs 1.7 0.81 (0.48–1.36)	3.1 vs 4.2 0.90 (0.58–1.11)	15.5 vs 18.8 0.76 (0.61–0.95)	18.2 vs 22.7 0.71 (0.57–0.90)

Abbreviations: MI, myocardial infarction; TLR, target lesion revascularization; MACEs, major adverse cardiac events; BMS, bare-metal stent; RVD, reference vessel diameter; OR, odds ratio; CI, confidence interval.

Table 2 Comparison of angiographic characteristics, death, MI, TLR, and MACEs, following SES and PES

Study	Total No. of patients	RVD (mm)	SES vs PES
			Death (%)	MI (%)	TLR (%)	MACE (%)
ISAR-SMART 3^Citation36	360	<2.75	1.7 vs 2.2 P = 0.99	3.9 vs 3.3 P = 0.78	6.6 vs 14.7 P = 0.008
Park et al^Citation38	197	<2.75	0 vs 0 P = 1	12.4 vs 13.2 P = 0.54	3.3 vs 14.4 P < 0.01	15.7 vs 27.6 P < 0.01
RESEARCH and T-SEARCH^Citation39,Citation40	199	<2.25	0.9 vs 4.3 P = 0.18	2.8 vs 7.8 P = 0.19	6.5 vs 11.1 P = 0.31	9.3 vs 18.9 P = 0.06
SIRTAX^Citation37	370	<2.75	6.0 vs 5.4 OR = 1.10; 95% CI, 0.47–2.60	3.8 vs 3.7 OR = 1.01; 95% CI, 0.35–2.88	6.0 vs 17.7 OR = 0.31; 95% CI, 0.16–0.62	10.4 vs 20.4 OR = 0.45; 95% CI, 0.26–0.78

Abbreviations: MI, myocardial infarction; TLR, target lesion revascularization; MACEs, major adverse cardiac events; RVD, reference vessel diameter; SES, sirolimus-eluting stent; PES, paclitaxel-eluting stent; OR, odds ratio; CI, confidence interval.

ParkSWLeeCWHongMKRandomized comparison of coronary stenting with optimal balloon angioplasty for treatment of lesions in small coronary arteriesEur Heart J2000211785178911052843

 PubMed Web of Science ®Google Scholar

KastratiASchomigADirschingerJA randomised trial comparing stenting with balloon angioplasty in small vessels in patients with symptomatic coronary artery disease. ISAR-SMART Study Investigators. Intracoronary stenting or angioplasty for restenosis reduction in small arteriesCirculation20001022593259811085962

 PubMed Web of Science ®Google Scholar

KoningREltchaninoffHCommeauPStent placement compared with balloon angioplasty for small coronary arteries: in-hospital and 6-month clinical and angiographic resultsCirculation20011041604160811581136

 PubMed Web of Science ®Google Scholar

DoucetCSchalijMJVrolixMCStent placement to prevent restenosis after angioplasty in small coronary arteriesCirculation20011042029203311673341

 PubMed Web of Science ®Google Scholar

MoerRMyrengYMolstadPStenting in small coronary arteries (SISCA) trialA randomised comparison between balloon angioplasty and the heparin-coated stentJ Am Coll Cardiol2001381598160311704369

 PubMed Web of Science ®Google Scholar

HaudeMKonorzaTFKalninsUErglisAHeparin-coated stent placement for the treatment of stenosis in small coronary arteries of symptomatic patientsCirculation20031071265127012628946

 PubMed Web of Science ®Google Scholar

KinsaraAJNiaziKPatelIAmoudiOEffectiveness of stents in small coronary arteriesAm J Cardiol20039258458712943880

 PubMedGoogle Scholar

HanekampCKoolenJBonnierHRandomised comparison of balloon angioplasty versus silicon carbon-coated stent implantation for de novo lesions in small coronary arteriesAm J Cardiol2004931233123715135695

 PubMed Web of Science ®Google Scholar

GarciaEGomez-ReicoMMorenoRStent reduces restenosis in small vessels. Results of the RAP study [abstract]J Am Coll Cardiol20013717A

 Web of Science ®Google Scholar

MuramatsuTIwasakiKInouNEfficacy of coronary stenting versus balloon angioplasty in vessels of diameter less than 3.0 mm and less than 2.5 mm: CHIVAS investigators [abstract]Am J Cardiol20029096H

 Google Scholar

HausleiterJKastratiAMehelliJA randomised trial comparing phosphorylcholine-coated stents with balloon angioplasty in small coronary arteries in patients with symptomatic coronary artery disease. The ISAR-SMART 2 Trial [abstract]Circulation2003108IV-569

 Google Scholar

RodriguezAERodriguez-AlemparteMJPereiraCFFinal angiographic and clinical results of the Latin America small vessel randomised study (LASMAL trial) [abstract]J AM Coll Cardiol20034126A12570940

 PubMedGoogle Scholar

RodriguezALASMAL-II: a prospective randomised trial of phosphorylcholine- coated stenting vs balloon angioplasty in small vessels in the diabetic patient (featured lecture)TCT2003 Available from: http://www.tctmd.com/expert-presentationsAccessed 2004 Jun 27

 Google Scholar

MehilliJDibraAKastratiARandomised trial of paclitaxeland sirolimus-eluting stents in small coronary vesselsEur Heart J20062726026616401670

 PubMed Web of Science ®Google Scholar

ParkKHParkSWHongMKComparison of the effectiveness of sirolimus- and paclitaxel-eluting stents for small coronary artery lesionsCatheter Cardiovasc Interv20066758959416547937

 PubMed Web of Science ®Google Scholar

Rodriguez-GranilloGAValgimigliMGarcia-GarciaHMOne-year clinical outcome after coronary stenting of very small vessels using 2.25 mm sirolimus- and paclitaxel-eluting stents: a comparison between the RESEARCH and T-SEARCH registriesJ Invasive Cardiol20051740941216079445

 PubMedGoogle Scholar

TanimotoSDaemenJTsuchidaKTwo-year clinical outcome after coronary stenting of small vessels using 2.25 mm sirolimus- and paclitaxel-eluting stents: insight into the RESEARCH and T-SEARCH registriesCatheter Cardiovasc Interv2007699410317139687

 PubMedGoogle Scholar

TogniMEberSWidmerJImpact of vessel size on outcome after implantation of sirolimus-eluting and paclitaxel-eluting stents: a sub-group analysis of the SIRTAX TrialJ Am Coll Cardiol2007501123113117868802

 PubMedGoogle Scholar