Percutaneous Coronary Interventions for the Treatment of Stenoses in Small Coronary Arteries: A Network Meta-Analysis.

Siontis, Georgios; Piccolo, Raffaele; Praz, Fabien; Valgimigli, Marco; Räber, Lorenz; Mavridis, Dimitris; Jüni, Peter; Windecker, Stephan (2016). Percutaneous Coronary Interventions for the Treatment of Stenoses in Small Coronary Arteries: A Network Meta-Analysis. JACC. Cardiovascular Interventions, 9(13), pp. 1324-1334. Elsevier 10.1016/j.jcin.2016.03.025

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Siontis, Georgios; Piccolo, Raffaele; Praz, Fabien; Valgimigli, Marco; Räber, Lorenz; Jüni, Peter and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1876-7605

Publisher:

Elsevier

Language:

English

Submitter:

Judith Liniger

Date Deposited:

12 Dec 2016 11:36

Last Modified:

03 Jan 2017 15:29

Publisher DOI:

10.1016/j.jcin.2016.03.025

PubMed ID:

27318845

Uncontrolled Keywords:

coronary disease; drug-coating balloon(s); drug-eluting stent(s); network meta-analysis; small coronary arteries

BORIS DOI:

10.7892/boris.89716

URI:

https://boris.unibe.ch/id/eprint/89716

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