Author + information
- Hui Wen Sim1,
- Rajiv Ananthakrishna1,
- Poay-Huan Loh1,
- Edgar Lik-Wui Tay1,
- Koo Hui Chan1,
- Mark Chan1,
- Ronald Chi-Hang Lee2,
- Adrian Low1,
- Huay Cheem Tan1 and
- Joshua P. Loh1
Treatment of very small coronary artery disease (CAD) remains challenging and controversial. To date, there is a paucity of data regarding the long-term outcome in this group of patients. We aim to compare the baseline demographics and long-term outcome between drug-eluting stents (DEs) and drug-eluting balloons (DEB) in the treatment of very small caliber CAD.
This is a single-center, retrospective, all-comers registry where we evaluated all percutaneous coronary intervention (PCI) on de novo CAD involving 2.0 mm DEB and 2.0 mm DES from January 2013 to November 2015. The primary outcome was the incidence of target lesion failure (TLF), defined as the combination of cardiac death, target vessel myocardial infarction (MI) and clinically driven target lesion revascularization (TLR) at one year.
A total 111 patients with 131 DES implantation (XIENCE Xpedition SV: 95, Resolute Onyx: 36) and 83 patients with 97 DEB treatment (Sequence Please: 92, Sequence Neo: 2, In. Pact Falcon: 3, 47 patients had concurrent DES in other lesions) were analyzed. The baseline demographics between the two groups were similar, except for higher prevalence of Hypertension and smoking history in a patient treated with DEB (Table 1). 62.2% of patient with DES and 62.7% patients with DEB presented with myocardial infarction. Those with DES implantation had more lesions in the main vessels (77.9% vs 57.7%, p=0.001) with higher complexity (AHA type B2/C, 77.9% vs 60.8%, p=0.005) as opposed to DEB. Lesion length was comparable between both groups (DES: 19.7 ± 7.3 mm vs DEB: 19.9 ± 10.4 mm, p=NS). At one year follow-up, all-cause mortality, cardiac mortality, TLR, and TLF did not differ significantly between the two groups. However, patients with DES implantation had a higher incidence of MI (7.2% vs.1.2%, p=0.049) as compared to DEB treatment.
|Variables, n (%)||2.0mm DES (n=111)||2.0mm DEB (n=83)||p value|
|Male||79 (71.2)||67 (80.7)||NS|
|Age (year)||61.6 ± 11.0||58.7 ± 11.9||NS|
|Diabetes||61 (55.0)||50 (60.2)||NS|
|Hypertension||73 (65.8)||71 (85.5)||0.002|
|Hyperlipidemia||81 (73.0)||67 (80.7)||NS|
|Family History of premature CAD||7 (6.3)||3 (3.6)||NS|
|Smoking||31 (27.9)||44 (47.0)||0.006|
|Prior MI||37 (33.3)||43 (51.8)||NS|
|Prior PCI||30 (27.0)||33 (39.8)||0.01|
|Prior CABG||6 (5.4)||5 (6.0)||NS|
|Outcome at one year|
|All-Cause mortality||10 (9.0)||2 (2.4)||NS|
|Cardiac mortality||3 (2.7)||2 (2.4)||NS|
|MI||8 (7.2)||1 (1.2)||0.049|
|TLR||6 (5.4)||1 (1.2)||NS|
|TLF||9 (8.1)||4 (4.8)||NS|
TLF in one year between 2.0 mm DES and 2.0 mm DEB in the treatment of very small caliber CAD were comparable, except for higher incidence of MI in the DES group. DEB can be considered as a treatment strategy for very small vessel caliber CAD with a favorable one-year outcome.