July 13, 2026European Heart Journal97 citationsOpen Access
View Full PaperIs bare-metal stenting superior to balloon angioplasty for small vessel coronary artery disease? Evidence from a meta-analysis of randomized trials
Key Result
Bare-metal stenting significantly reduced major adverse cardiac events compared to balloon angioplasty in small coronary arteries (17.6% vs 22.7%; OR 0.71, 95% CI 0.57-0.90).
Key Points
- This research aims to evaluate the effectiveness of bare-metal stenting compared to balloon angioplasty for small coronary artery disease.
- Meta-analysis of 13 randomized trials
- Trials included patients with reference vessel diameter <3 mm and follow-up ≥6 months
- Outcome measures included death, myocardial infarction, repeat revascularization, and major adverse cardiac events.
- No significant differences in death and myocardial infarction between groups.
- Stenting showed lower major adverse cardiac events (17.6%) compared to angioplasty (22.7%), OR 0.71 (0.57-0.90).
- After optimal angioplasty, MACE rates were similar; stenting showed advantage in suboptimal cases (stenting 17.3% vs. angioplasty 24%, OR 0.62 (0.44-0.88)).
Study Design
Type
Meta-Analysis (n=4,383)
Structured PICO
Does bare-metal stenting reduce MACEs compared to balloon angioplasty in patients with small vessel coronary artery disease?
P
Population
4,383 patients from 13 randomized trials comparing bare-metal stenting versus balloon angioplasty for lesions in small coronary arteries (<3 mm) with at least 6 months of follow-up.
I
Intervention
Bare-metal stenting
C
Comparator
Balloon angioplasty
O
Outcome
Major adverse cardiac events (MACEs)composite
Bare-metal stenting reduces MACEs compared to balloon angioplasty in small coronary arteries, primarily driven by reduced repeat revascularization, though optimal balloon angioplasty yields similar results to routine stenting.
Main Result
Odds Ratio: 0.71 (95% CI 0.57–0.9)
Absolute Event Rate: 17.6% vs 22.7%
Limitations
- Heterogeneity among trials was present.
Abstract
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 diameteror=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 stenosis20%) 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.