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

Jorge Sanz-Sánchez1,2, Mauro Chiarito3,4, Gauravpal S Gill5

  • 1Hospital Universitari i Politecnic La Fe, Valencia, Spain.

Journal of the Society for Cardiovascular Angiography & Interventions
|August 12, 2024
PubMed

Insights

Small vessel coronary artery disease (CAD) affects many patients undergoing procedures. This review proposes a <2.5mm vessel diameter definition for small vessel CAD to improve future research and patient care.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Biology

Background:

  • Small vessel coronary artery disease (CAD) is a common finding in patients undergoing percutaneous coronary intervention (PCI).
  • It presents a significant clinical challenge due to increased risks of procedural failure, restenosis, and repeat revascularization.
  • Current definitions of small vessel size lack consistency, leading to heterogeneous trial outcomes.

Purpose of the Study:

  • To critically review existing literature on small vessel CAD.
  • To propose a standardized definition for small vessel CAD using a reference vessel diameter of <2.5mm.
  • To guide future clinical trials and decision-making in managing small vessel CAD.

Main Methods:

  • Comprehensive literature review of studies reporting on small vessel coronary artery disease.
  • Analysis of existing definitions and their impact on clinical outcomes.
  • Synthesis of evidence to propose a consistent diagnostic criterion.

Main Results:

  • Small vessel CAD prevalence varies widely (30-67%) in PCI populations.
  • Inconsistent definitions contribute to heterogeneity in reported safety and efficacy of revascularization.
  • A reference vessel diameter <2.5mm is proposed as a consistent definition.

Conclusions:

  • Standardizing the definition of small vessel CAD is crucial for advancing treatment strategies.
  • The proposed <2.5mm diameter offers a clear criterion for future research and clinical practice.
  • This definition aims to reduce heterogeneity and improve outcomes for patients with small vessel CAD.

Keywords:
coronary artery diseasesmall vessel

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