Coronary stenting versus balloon angioplasty in small vessels
| Autor: | Cristina Fernández, Carlos Macaya, Camino Bañuelos, Fernando Alfonso, Rosana Hernández, Luis Azcona, Javier Escaned, Manel Sabaté, Dominick J. Angiolillo, María José Pérez-Vizcayno, Raúl Moreno |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
medicine.medical_specialty
education.field_of_study business.industry medicine.medical_treatment Population Stent Balloon medicine.disease law.invention Surgery Coronary arteries medicine.anatomical_structure Randomized controlled trial Restenosis law Relative risk Angioplasty medicine business education Cardiology and Cardiovascular Medicine |
| Zdroj: | Journal of the American College of Cardiology. 43(11):1964-1972 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/j.jacc.2004.01.039 |
| Popis: | 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 The BeStent (Medtronic Instent, Minneapolis, Minnesota) was used in four studies, the Multi-Link (Guidant, Advanced Cardiovascular Systems Inc., Santa Clara, California) in three trials, and the NIR (Boston Scientific Corp., Boston, Massachusetts), JoStent (Jomed International AB, Helsingborg, Sweden), Tenax (Biotronik, Berlin, Germany), and BioDivysio (Abbott Vascular Devices, Redwood City, California) in the remaining four trials. Overall, 3,541 patients were included (1,672 allocated to BA and 1,869 to stent). The rate of cross-over from balloon to stent in the pooled population was 19%, and unsuccessful stent deployment occurred in 2% of the patients allocated to stent. The pooled rates of restenosis were 25.8% and 34.2% in patients allocated to stent and balloon, respectively (p = 0.003) (risk ratio [RR] 0.77; 95% confidence interval [CI] 0.65 to 0.92). A smaller reference vessel diameter at baseline was associated with a higher risk reduction in the restenosis rate (y = −3.551 + 1.826 [x]; p = 0.012). Patients allocated to stent had lower rates of major adverse cardiac events (15.0% vs. 21.8%, p = 0.002; RR 0.70; 95% CI 0.57 to 0.87) and new target vessel revascularizations (12.5% vs. 17.0%, p = 0.004; RR 0.75, 95% CI 0.61 to 0.91). Conclusions Elective stenting is superior to provisional stenting in small coronary arteries. This benefit is more evident in smaller coronary arteries. |
| Databáze: | OpenAIRE |
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