Small vessel coronary artery disease: How small can we go with myocardial revascularization?

Wybraniec, Maciej T.; Bańka, Paweł; Bochenek, Tomasz; Roleder, Tomasz; Mizia-Stec, Katarzyna

doi:10.5603/cj.a2020.0127

Cited by 12 publications

(15 citation statements)

References 76 publications

(104 reference statements)

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“…Although previous data provided evidence for a higher rate of restenosis in patients with SVD subject to PCI, our study did not provide data to support it [5]. While restenosis was more common in patients with SVD, the difference did not reach statistical significance.…”

Section: Discussioncontrasting

confidence: 95%

Prognostic significance of small vessel coronary artery disease in patients with acute coronary syndromes treated with percutaneous coronary interventions

Kampka¹,

Drabczyk²,

Żak³

et al. 2023

pwki

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Introduction: Small vessel disease (SVD) usually refers to atherosclerosis within vessels of diameter of < 2.5 mm. Conflicting data exist regarding the outcomes of its revascularization.Aim: To evaluate the outcome of invasive treatment in patients with acute coronary syndromes (ACS) and SVD and the predictors of angina recurrence after percutaneous coronary intervention (PCI).Material and methods: This was an observational, retrospective, single-center study. It covered consecutive 127 patients (26.77% women; median age: 69.74 ±8.97 years) with ACS who underwent PCI in the Upper-Silesian Medical Center in Katowice between 2018 and 2020. The study population was stratified by means of presence of SVD defined by PCI of the culprit artery with a diameter of ≤ 2.5 mm. The major adverse cardiac and cerebrovascular events (MACCE) and angina recurrence were analyzed in a 12-month follow-up period.Results: Overall 99 (77.95%) patients were diagnosed with small-vessel coronary artery disease. MACCE were documented in 14 (11.02%) patients. Univariate analysis revealed the following factors associated with MACCE: left ventricle ejection fraction (LVEF) (OR = 0.95, p = 0.0212), left main (LM) stenting (OR = 18.17, p = 0.0216), number of former PCIs (OR = 1.48, p = 0.0235). According to logistic regression analysis the factors were LM stenting (OR = 20.04, p = 0.0216) and number of former PCIs (OR = 1.53, p = 0.0203). Patients with SVD had more often refractory or recurrent angina in symptomatic class III/IV on follow-up (52.53% vs. 10.71%, p < 0.001).Conclusions: Outcome of invasive treatment in patients with ACS is related to LM stenting and former PCIs but not to SVD occurrence. Patients with SVD have a high rate of recurrent/refractory angina despite successful PCI in this clinical setting.

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Section: Discussioncontrasting

confidence: 95%

Prognostic significance of small vessel coronary artery disease in patients with acute coronary syndromes treated with percutaneous coronary interventions

Kampka¹,

Drabczyk²,

Żak³

et al. 2023

pwki

Self Cite

View full text Add to dashboard Cite

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“…Coronary vessel diameter has a continuous inverse relationship with procedural complexity and the incidence of cardiac events [4,14,15]. Correspondingly, the definitions of what constitute a small vessel is arbitrary, varies between studies and has evolved over time [6]. Initially, in the early days of bare metal stents, vessels ≤ 2.9 mm in lumen diameter were considered small [16].…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of small vessel treatment among patients undergoing a percutaneous coronary intervention (PCI) has been reported to be around 35-50% of the cases [1][2][3][4]. For the interventional cardiologist, small vessel PCI constitute a technical challenge as small vessels are more distally located in the coronary system with frequently a diffuse distribution of the atherosclerotic narrowing's rather than a discrete lesion [5,6]. Moreover, small vessel disease is associated with an increased risk for a cardiac event, including Koki Shishido is a first author.…”

Section: Introductionmentioning

confidence: 99%

Five-year clinical outcomes of a 2.25 mm sirolimus-eluting stent in Japanese patients with very small coronary artery disease: final results of the CENTURY JSV study

Shishido

Ando

Ito

et al. 2022

Cardiovasc Interv and Ther

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The aim of this study is to evaluate the long-term safety and efficacy of the 2.25 mm bioresorbable-polymer sirolimus-eluting Ultimaster stent in a Japanese patient population. Treatment of coronary artery disease in very small vessels is associated with an increased risk for cardiac events. The CENTURY JSV study is a prospective, multicenter, single-arm study. Seventy patients with stable and unstable coronary artery disease with a coronary lesion eligible for implantation with a 2.25 mm stent were enrolled in this study. Patients underwent clinical follow-up through 5-year after the PCI procedure. The mean age was 70.4 ± 9.2 years. The prevalence of diabetes mellitus was 37.1%, all not insulin dependent. The incidence of major adverse cardiac events, defined as cardiac death, target vessel myocardial infarction (MI), and clinically driven target lesion revascularization (CD-TLR) at 5 years was 5.7%. A non-Q wave MI was noted in 1.4% and 4.3% underwent a CD-TLR. There was no stent thrombosis during the entire follow-up period. No cardiac events were reported between 2 and 5 years. This is the first study to demonstrate safety and effectiveness for 5 years after treatment of very small coronary disease with 2.25 mm-diameter DES.Clinical trial registration: UMIN000012928

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“…Coronary artery SVD accounts for 30% of patients needing interventional therapy and is more common in women or the elderly and patients with diabetes or kidney disease (45). The small vessel diameter makes it challenging for stent implantation (46). Moreover, previous studies have shown that small vessel diameter is the strongest inducer of restenosis among all clinical factors (47), which leads to the high probability of ISR in SVD after DES treatment.…”

Section: Application Of Dcb In Small Vessel Diseasementioning

confidence: 99%

Novel application of drug-coated balloons in coronary heart disease: A narrative review

Wang

Li²,

Li³

et al. 2023

Front. Cardiovasc. Med.

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The incidence of coronary heart disease (CAD) has soared over the years, and coronary intervention has become an increasingly important therapeutic approach. The past decade has witnessed unprecedented developments in therapeutic medical instruments. Given that drug-coated balloons bring many benefits, they are indicated for an increasing number of conditions. In this article, we review the results of current clinical trials about drug-coated balloons and summarize their safety and clinical progression in different coronary artery diseases, laying the groundwork for basic research, and clinical therapeutics of this patient population.

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Small vessel coronary artery disease: How small can we go with myocardial revascularization?

Cited by 12 publications

References 76 publications

Prognostic significance of small vessel coronary artery disease in patients with acute coronary syndromes treated with percutaneous coronary interventions

Prognostic significance of small vessel coronary artery disease in patients with acute coronary syndromes treated with percutaneous coronary interventions

Five-year clinical outcomes of a 2.25 mm sirolimus-eluting stent in Japanese patients with very small coronary artery disease: final results of the CENTURY JSV study

Novel application of drug-coated balloons in coronary heart disease: A narrative review

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