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

نویسندگان

  • 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
چکیده

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>or=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.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Coronary stenting versus balloon angioplasty in small vessels: a meta-analysis from 11 randomized studies.

OBJECTIVES A meta-analysis of 11 randomized trials was done to compare stenting versus balloon angioplasty (BA) in small coronary vessels. BACKGROUND Randomized studies on coronary stenting (CS) in small vessels have yielded controversial results. METHODS Eleven randomized trials on CS versus BA in small vessels, including angiographic re-evaluation at six months, were analyzed. RESULTS T...

متن کامل

Evaluation of PTCA versus Stenting and Bare-Metal Stenting versus Drug-Eluting Stenting in the Treatment of Coronary Artery Disease

Introduction: The risk of developing coronary artery disease (CAD) for both men and women is increasing in society today. Over the past twenty-five years, the concepts of percutaneous transluminal coronary angioplasty (PTCA) and stenting have become dominant modalities in the treatment of CAD. In the late 1970’s and early 1980’s, PTCA was seen as the best possible alternative to bypass surgery ...

متن کامل

بررسی نتیجه کلینیکی بلند مدت آنژیوپلاستی با استنت فلزی در بیماران مبتلا به بیماری عروق کرونر در بیمارستان فاطمه زهرا (س) ساری از سال 1383 تا سال 1385

Background and Purpose:Coronary artery Stenting is known to improve the outcome for ischemic heart disease. Many clinical studies have been performed to determine the long-term outcome of coronary Stenting and most of them were based on first-generation bare-metal Stents. The aim of this study is to evaluate long-term (24 6.4 month) results of second-generation bare metal stent. Materials an...

متن کامل

Clinical outcomes of stents versus balloon angioplasty in non-acute coronary artery disease. A meta-analysis of randomized controlled trials.

AIMS To evaluate whether stents as compared to balloon angioplasty reduce mortality in patients with non-acute coronary artery disease. METHODS AND RESULTS We identified randomized controlled trials comparing stents to balloon angioplasty for the treatment of non-acute coronary artery disease by searching major medical databases from 1979 to March 2002. Two independent reviewers selected and ...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • European heart journal

دوره 26 9  شماره 

صفحات  -

تاریخ انتشار 2005