Skip Navigation


European Heart Journal Advance Access originally published online on January 28, 2005
European Heart Journal 2005 26(9):881-889; doi:10.1093/eurheartj/ehi116
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
26/9/881    most recent
ehi116v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (17)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Agostoni, P.
Right arrow Articles by Serruys, P. W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Agostoni, P.
Right arrow Articles by Serruys, P. W.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

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

Pierfrancesco Agostoni1,2,*, Giuseppe G.L. Biondi-Zoccai3, Gabriele L. Gasparini1, Maurizio Anselmi1, Giorgio Morando1, Marco Turri1, Antonio Abbate4, Eugene P. McFadden2, Corrado Vassanelli1, Piero Zardini1, Antonio Colombo3 and Patrick W. Serruys2

1Department of Biomedical and Surgical Sciences, Section of Cardiology, University of Verona, Piazzale Stefani 1, 37126 Verona, Italy
2Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
3S. Raffaele Hospital, ‘Vita e Salute’ University, University of Milan, Milan, Italy
4Department of Medicine, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA, USA

Received 21 September 2004; revised 3 November 2004; accepted 9 December 2004; online publish-ahead-of-print 28 January 2005.

* Corresponding author. Tel: +39 49 4303888; fax: +39 045 914727. E-mail address: agostonipf{at}genie.it

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 <3 mm, and follow-up ≥6 months. Random effect odds ratios (OR) for death, myocardial infarction (MI), repeat revascularization (RR), and major adverse cardiac events (MACEs) were computed. In a pre-specified subgroup analysis, we compared stenting with optimal (post-procedural stenosis <20%) and suboptimal (>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.

Key Words: Meta-analysis • Stent • Balloon angioplasty • Small coronary arteries


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 J Am Coll CardiolHome page
M. Togni, S. Eber, J. Widmer, M. Billinger, P. Wenaweser, S. Cook, R. Vogel, C. Seiler, F. R. Eberli, W. Maier, et al.
Impact of Vessel Size on Outcome After Implantation of Sirolimus-Eluting and Paclitaxel-Eluting Stents: A Subgroup Analysis of the SIRTAX Trial
J. Am. Coll. Cardiol., September 18, 2007; 50(12): 1123 - 1131.
[Abstract] [Full Text] [PDF]

Home page
 Br J AnaesthHome page
P.-G. Chassot, A. Delabays, and D. R. Spahn
Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction
Br. J. Anaesth., September 1, 2007; 99(3): 316 - 328.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
S. Elezi, A. Dibra, J. Mehilli, J. Pache, R. Wessely, A. Schomig, and A. Kastrati
Vessel Size and Outcome After Coronary Drug-Eluting Stent Placement: Results From a Large Cohort of Patients Treated With Sirolimus- or Paclitaxel-Eluting Stents
J. Am. Coll. Cardiol., October 3, 2006; 48(7): 1304 - 1309.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
R. Shroff, D. J. Roebuck, I. Gordon, R. Davies, S. Stephens, S. Marks, M. Chan, M. Barkovics, C. A. McLaren, V. Shah, et al.
Angioplasty for Renovascular Hypertension in Children: 20-Year Experience
Pediatrics, July 1, 2006; 118(1): 268 - 275.
[Abstract] [Full Text] [PDF]

Home page
 BMJHome page
G. G L Biondi-Zoccai, M. Lotrionte, A. Abbate, L. Testa, E. Remigi, F. Burzotta, M. Valgimigli, E. Romagnoli, F. Crea, and P. Agostoni
Compliance with QUOROM and quality of reporting of overlapping meta-analyses on the role of acetylcysteine in the prevention of contrast associated nephropathy: case study
BMJ, January 28, 2006; 332(7535): 202 - 209.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
G. De Luca, H. Suryapranata, G. Gregorio, H. Lange, and M. Chiariello
Homocysteine and Its Effects on In-Stent Restenosis
Circulation, November 8, 2005; 112(19): e307 - e311.
[Full Text] [PDF]

Home page
 JAMAHome page
G. W. Stone, S. G. Ellis, L. Cannon, J. T. Mann, J. D. Greenberg, D. Spriggs, C. D. O'Shaughnessy, S. DeMaio, P. Hall, J. J. Popma, et al.
Comparison of a Polymer-Based Paclitaxel-Eluting Stent With a Bare Metal Stent in Patients With Complex Coronary Artery Disease: A Randomized Controlled Trial
JAMA, September 14, 2005; 294(10): 1215 - 1223.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
R. Moreno, C. Fernandez, and C. Macaya
Coronary stenting in small vessels
Eur. Heart J., August 1, 2005; 26(15): 1562 - 1562.
[Full Text] [PDF]


Disclaimer:
Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.