Comparative effectiveness of percutaneous coronary intervention strategies for coronary small-vessel disease: a network meta-analysis of randomized trials.
Changjiang Deng, Chao Fan, Zhiyan Du et al.
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In 30 seconds
This systematic review and network meta-analysis compared percutaneous coronary intervention strategies for angiographic small-vessel disease (reference vessel diameter ≤3.0 mm), using randomized trials in adults. Across 39 trials and 14,503 patients, sirolimus-eluting stents (SES) ranked highest overall across target lesion revascularization, binary restenosis, and myocardial infarction outcomes. For example, SES was associated with lower odds of target lesion revascularization than bare-metal stents (OR, 0.25; 95% CI, 0.15-0.43). Zotarolimus- and everolimus-eluting stents and paclitaxel-coated balloons also ranked highly for selected outcomes.
Key findings
- For target lesion revascularization, SES had the highest SUCRA ranking (90.1%), followed by ZES (83.9%) and EES (82.2%).
- For binary restenosis, SES ranked highest (95.0%), followed by ZES (80.0%) and paclitaxel-coated balloons (78.3%).
- For myocardial infarction, SES ranked highest (79.0%), followed by paclitaxel-coated balloons (78.7%) and ZES (68.5%).
- Compared with BMS, SES reduced odds of target lesion revascularization (OR, 0.25; 95% CI, 0.15-0.43) and myocardial infarction (OR, 0.41; 95% CI, 0.21-0.79).
Why it matters
Small coronary vessel calibre makes restenosis and ischemic outcomes important considerations in PCI. This synthesis compares multiple device strategies across randomized trials and suggests that their performance is not equivalent, with SES consistently ranking highly and conventional approaches ranking poorly. The findings provide comparative evidence for understanding device options, while rankings should be interpreted alongside the outcomes and comparisons reported.
What to keep in mind
The analysis depends on the available randomized trials and their reported outcomes; treatment rankings are comparative estimates rather than direct evidence that one strategy is best for every clinical setting.