Which PCI strategy is best for small coronary artery stenosis?

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  • For treating stenoses in small coronary arteries, early-generation sirolimus-eluting stents (SES) offer the most favorable angiographic and clinical outcomes compared with the 5 most common types of percutaneous coronary intervention (PCI).

Study design

  • Meta-analysis of randomized trials comparing any PCI strategy for the treatment of coronary stenosis located exclusively in vessels of small diameter.
  • Trials with 2 or more arms were eligible.
  • 19 trials were included in final analysis, with 5072 patients comprising a network without closed loops among 5 identified interventions: early-generation SES, paclitaxel-eluting stents (PES), drug-coated balloons (DCB), bare-metal stents (BMS), and balloon angioplasty (BA).
  • Primary angiographic outcome was percentage diameter stenosis (%DS).

Key results

  • No dedicated trial evaluating new-generation drug-eluting stents was identified.
  • Early-generation SES yielded the best angiographic results according to %DS.
  • For %DS, SES was ranked as the most effective treatmen...