Small Vessel Coronary Artery Disease: Rationale for Standardized Definition and Critical Appraisal of the Literature

Sanz‐Sánchez, Jorge; Chiarito, Mauro; Gill, Gauravpal S.; Heijden, Liefke C. van der; Piña, Yigal; Cortese, Bernardo; Alfonso, Fernándo; Birgelen, Clemens von; Gil, José Luis Díez; Waksman, Ron

doi:10.1016/j.jscai.2022.100403

Cited by 8 publications

(13 citation statements)

References 57 publications

(73 reference statements)

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“…In a cohort of 10,004 patients with 6-8-month angiographic surveillance, small vessel size and complex lesion morphology were strong correlates of ISR [71]. Small vessel treatment is a challenging setting because of an increased risk of restenosis and the need for repeat revascularization [92]. Contemporary newergeneration DES significantly reduced both late lumen loss and restenosis in these complex lesions [93].…”

Section: In-stent Restenosismentioning

confidence: 99%

Stent Thrombosis and Restenosis with Contemporary Drug-Eluting Stents: Predictors and Current Evidence

Condello

Spaccarotella

Sorrentino

et al. 2023

JCM

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Iterations in stent technologies, advances in pharmacotherapy, and awareness of the implications of implantation techniques have markedly reduced the risk of stent failure, both in the form of stent thrombosis (ST) and in-stent restenosis (ISR). However, given the number of percutaneous coronary interventions (PCI) performed worldwide every year, ST and ISR, albeit occurring at a fairly low rate, represent a public health problem even with contemporary DES platforms. The understanding of mechanisms and risk factors for these two PCI complications has been of fundamental importance for the parallel evolution of stent technologies. Risk factors associated with ST and ISR are usually divided into patient-, lesion-, device- and procedure-related. A number of studies have shown how certain risk factors are related to early (1 month) versus late/very late ST (between 1 month and 1 year and >1 year, respectively). However, more research is required to conclusively show the role of time-dependence of risk factors also in the incidence of ISR (early [1 year] or late [>1 year]). A thorough risk assessment is required due to the complex etiology of ST and ISR. The most effective strategy to treat ST and ISR is still to prevent them; hence, it is crucial to identify patient-, lesion-, device- and procedure-related predictors.

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Section: In-stent Restenosismentioning

confidence: 99%

Stent Thrombosis and Restenosis with Contemporary Drug-Eluting Stents: Predictors and Current Evidence

Condello

Spaccarotella

Sorrentino

et al. 2023

JCM

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“…In this issue of JSCAI, Sanz-S anchez et al 1 propose that a reference vessel diameter (RVD) of <2.5 mm measured with intracoronary imaging (ICI) should be adopted as the standardized definition of small vessel coronary artery disease (CAD). They correctly note that there is currently no standardized definition for small vessel CAD and suggest that adopting this definition may be useful to guide both clinical decision-making and future clinical trials.…”

Section: -Socratesmentioning

confidence: 99%

Small Coronary Vessel Size: A Great Need for a Standardized Definition

Coughlan

Kastrati

2022

Journal of the Society for Cardiovascular Angiography & Int

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“…[4][5][6] The definition of small vessel CAD varies across trials until the Society for Cardiovascular Angiography recently published a literature suggesting a reference vessel diameter (RVD) < 2.5 mm as the cutoff value for classifying small coronary vessels. 5,7,8 The evolution of stent technology and the availability of 2.25-mm and 2.0-mm drug-eluting stents (DES) has led to very small vessel CAD being proposed to describe the lesions that are only amenable to these devices. 9,10 Although studies have indicated no significant difference in clinical outcome between 2.25 and 2.0-mm zotarolimus DES at 1year follow-up, 10 the long-term efficacy and safety of 2.0-mm DES remain unclear.…”

Section: Introductionmentioning

confidence: 99%

Long‐term outcomes after stent implantation in very small vessel coronary artery disease

Liu

Yang

Tai

et al. 2023

Clinical Cardiology

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Background: Percutaneous coronary interventions (PCI) in very small vessel lesions represent an intriguing aspect of coronary artery disease (CAD). Uncertainty still exists in stent implantation in very small caliber vessels. This study aimed to evaluate the long-term outcomes of patients treated with 2.0-mm drug-eluting stent (DES).Method: This retrospective observational study included 134 patients undergoing PCI with 2.0-mm zotarolimus DES from December 2016 to May 2020. The primary endpoint was major adverse cardiovascular events (MACE) at 2-year follow-up, which was composed of all-cause mortality, target vessel myocardial infarction, and ischemia-driven target lesion revascularization. Multiple logistic regression analysis was used to identify the independent predictors of MACE, and odds ratios (OR) and 95% confidence intervals (CI) were calculated.Result: The lesions were diffuse (mean length 20.9 ± 5.51 mm) and belong to type B2/C lesions (90.3%). On follow-up, the MACE rate was 20.1% and mostly driven by late lumen loss demanding revascularization (11.9%). In multivariable analysis, chronic kidney disease (CKD) (OR: 4.291, 95% CI: 1.574−11.704, p = 0.004) and calcified lesions (OR: 3.688, 95% CI: 1.311−10.371, p = 0.013) were the independent predictors of subsequent cardiovascular events, whereas statin was associated with better outcomes (OR: 0.335, 95% CI: 0.119−0.949, p = 0.040).Conclusion: 2.0-mm DES is a feasible option for treating very small vessel CAD in complex lesions. Patients with CKD and calcified lesions carry the hazard of worse outcomes, and careful consideration should be taken before stenting in this high-risk population.

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Small Vessel Coronary Artery Disease: Rationale for Standardized Definition and Critical Appraisal of the Literature

Cited by 8 publications

References 57 publications

Stent Thrombosis and Restenosis with Contemporary Drug-Eluting Stents: Predictors and Current Evidence

Stent Thrombosis and Restenosis with Contemporary Drug-Eluting Stents: Predictors and Current Evidence

Small Coronary Vessel Size: A Great Need for a Standardized Definition

Long‐term outcomes after stent implantation in very small vessel coronary artery disease

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