Study Comparing Coronary Stenting in Smaller Vessels Versus Large Vessels

Abstract

AbstractBackground: Smaller vessel PTCA account to approximately on third of all PTCA worldwide. With increasing incidence of diabetes mellitus and aging, this proportion can increase considerably. This is a region of interest for us because Indians, in particular, are known to have smaller coronaries. There are limited studies in coronary vessels < 2.5 are available. Most of the previous studies defined small vessel as < 3 or 2.75 mm.Methods and Results: This is an observational single center study where we analyzed 650 patients, 52 in the small vessel group(< 2.5 mm) and 598 in large vessel group(≥ 2.5 mm) with similar mean age between the both the groups (57.5±11.4 vs 57.9±11.1 yrs). Hypertension and smoking are more in large vessel group (74.7% vs 61.9, p=0.004; 22.1% vs 13.4%, p=0.007), whereas no difference for presence of diabetes (54.2% vs 54.3%) or type of CAD (CSA – chronic stable angina – 70.3% vs 76.1%, p=0.2). Large vessel group patients had more LV dysfunction (40.3% vs 24.6%, p=0.000).Mean Pre reference diameter was 1.9±0.5mm in small vessel group versus 2.9±0.5mm in large vessel group. Mean minimum lesion diameter in small vessel group is 0.8±0.3 mm versus 1.3±1.9 mm in large vessel group. Mean pre-lesion length is 16.7±3.5 mm in small vessel group versus 18.3±8.3mm in large vessel group. Mean stent size is 2.33mm in small vessel group versus 3.04mm in large vessel group. Mean stent length is 17.27mm in small vessel group versus 21.8mm in large vessel group. The success of PCI in small vessel group was 96% (not able to deliver stent in one patient and in one patient there was a non-flow limiting distal stent dissection) and 98% in large vessel group.In one year follow-up, 5 (3.5%) patients from small vessel group and 34 (4.5%) patients from large vessel group had MACCE which is not statistically significant (p=0.6)Conclusions: Small vessel (really small means less than 2.5 mm) PCI, not only acute but also one-year results are good with MACCE rate of 3.5% and comparable to large vessel PCI.