Coronary stenting in vessels <2.5 mm resulted in a significantly lower event-free survival rate at 28 months compared to vessels >3.0 mm and 3.0-2.5 mm (71% vs. 85% and 82%; P=0.002).
Cohort (n=1,152)
Does coronary stenting in small vessels (<2.5 mm) worsen angiographic restenosis and event-free survival compared to larger vessels in patients undergoing PCI?
Stenting in small coronary vessels (<2.5 mm) is safe acutely but is associated with higher rates of angiographic restenosis and lower long-term event-free survival compared to larger vessels.
Absolute Event Rate: 71% vs 85%
p-value: p=0.002
We compared the acute and long-term outcomes of stentings in coronary vessels > 3.0 mm, 3.0-2.5 mm, and 3.0 mm, group B 485 patients (544 lesions) with a reference vessel diameter of 3.0-2.5 mm, and group C 114 patients (119 lesions) with a reference vessel diameter < 2.5 mm. The procedural success, stent thrombosis, and in-hospital cardiac event rate were similar in the three groups. At 6-month angiographic follow-up, the lesion restenotic rate was significantly higher in the small-vessel group (14%, 22%, and 26% in groups A, B, and C, respectively; P = 0.011). These differences appeared to result from a lesser acute gain and a lesser net gain in small-vessel group; the late luminal loss was similar in the three groups. During a follow-up duration of 28 +/- 3 months, group C patients had a significantly lower rate of event-free survival than the group A and B patients (71% vs. 85% and 82%; P = 0.002). Stepwise regression analysis demonstrated that complex lesion (P = 0.032) and long lesion (P = 0.046) are independent predictors of restenosis in very-small-vessel (< 2.5 mm) stenting. In conclusion, the acute results of stenting in small coronary arteries appear safe and feasible with a high procedural success rate and a low incidence of stent thrombosis. Stenting in patients with a small coronary artery appears to have a similar in-hospital cardiac event rate, but a higher angiographic restenosis rate and a lower event-free survival rate, compared to stenting in patients with a larger coronary artery. The predictors of restenosis in very-small-vessel stenting are complex lesions and long lesions. Cathet Cardiovasc Intervent 2001;53:314-322.
Hsieh et al. (Fri,) conducted a cohort in Coronary artery disease requiring stenting (n=1,152). Coronary stenting in vessels < 2.5 mm vs. Coronary stenting in vessels > 3.0 mm and 3.0-2.5 mm was evaluated on Event-free survival (p=0.002). Coronary stenting in vessels <2.5 mm resulted in a significantly lower event-free survival rate at 28 months compared to vessels >3.0 mm and 3.0-2.5 mm (71% vs. 85% and 82%; P=0.002).
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