George C M Siontis1, Raffaele Piccolo1, Fabien Praz1, Marco Valgimigli1, Lorenz Räber1, Dimitris Mavridis2, Peter Jüni3, Stephan Windecker4. 1. Department of Cardiology, University Hospital Bern, Bern, Switzerland. 2. Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece. 3. Institute of Primary Health Care and Clinical Trials Unit, University of Bern, Bern, Switzerland. 4. Department of Cardiology, University Hospital Bern, Bern, Switzerland. Electronic address: stephan.windecker@insel.ch.
Abstract
OBJECTIVES: This study evaluated the most appropriate percutaneous coronary intervention (PCI) for the treatment of stenoses in small coronary arteries. BACKGROUND: PCI in small coronary arteries is associated with an increased risk of lesion failure and restenosis. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
OBJECTIVES: This study evaluated the most appropriate percutaneous coronary intervention (PCI) for the treatment of stenoses in small coronary arteries. BACKGROUND: PCI in small coronary arteries is associated with an increased risk of lesion failure and restenosis. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Authors: Maciej T Wybraniec; Paweł Bańka; Tomasz Bochenek; Tomasz Roleder; Katarzyna Mizia-Stec Journal: Cardiol J Date: 2020-09-28 Impact factor: 2.737
Authors: Nicole Gilgen; Ahmed Farah; Bruno Scheller; Marc-Alexander Ohlow; Norman Mangner; Daniel Weilenmann; Jochen Wöhrle; Peiman Jamshidi; Gregor Leibundgut; Sven Möbius-Winkler; Robert Zweiker; Florian Krackhardt; Christian Butter; Leonhard Bruch; Christoph Kaiser; Andreas Hoffmann; Peter Rickenbacher; Christian Mueller; Frank-Peter Stephan; Michael Coslovsky; Raban Jeger Journal: Clin Cardiol Date: 2018-05-10 Impact factor: 2.882