Table 25: Overall Quality of Evidence on High-Risk Lesions.

Outcome	Design	Quality	Consistency	Directness	Overall Quality
Long Lesions Significant ⇓6m MLD Significant ⇓ 6-m restenosis, 1-yr MACE & TLR	1 small RCT	N=144 Narrow spectrum Blinded Angiographic analysis Power calculation ITT Some limitation*	NA	Criteria for optimal stent implantation Definition for outcomes	Moderate Needs to be confirmed with larger RCTs
Diabetes No significant difference in MACE, death, MI or TVR	1 small subgroup analysis of RCT	Prospectively designed subgroup analysis of RCT Small sample (N = 54) Significant limitations**	NA	Same as above	Weak evidence – hypothesis generating
Unprotected left main C artery No significant difference in angio outcome sor MACE	2 small non-randomized Case-controlled Studies	Small samples (N = 58&127) Use of lVUS @ discretion of operator Selection bias No power calculation Possible type 2 error	Measured different parameters	Criteria for optimal stent implantation	Poor Cannot draw conclusion

m month; MLD minimal lumen diameter; MACE major adverse cardiac event; TLR target lesion revascularization; TVR target vessel revascularization; MI myocardial infarction

^*Limitations: single center, small sample, narrow spectrum (de novo, native coronary, non-ostial, only one type of stent)

^**Limitations: subgroup analysis, small sample, inadequate power to detect a difference