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Percutaneous coronary intervention versus coronary artery bypass graft for stable angina: meta-regression of

Fabrizio D'Ascenzo1, Umberto Barbero2, Claudio Moretti1

  • 1Division of Cardiology, University of Turin, Italy; Meta-analysis and Evidence based medicine Training in Cardiology (METCARDIO), Italy.

Contemporary Clinical Trials
|March 25, 2014
PubMed

Insights

Percutaneous coronary intervention (PCI) reduces stroke risk compared to coronary artery bypass grafting (CABG), especially in women. However, PCI increases revascularization risk, particularly for women and diabetic patients.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are revascularization strategies for stable angina.
  • Their comparative effectiveness regarding mortality and myocardial infarction is established, but clinical variable impact on risk-benefit is unclear.

Purpose of the Study:

  • To assess the impact of clinical variables on the risk-benefit profile of PCI versus CABG in stable angina.
  • To evaluate outcomes including death, myocardial infarction, repeat revascularization, and stroke.

Main Methods:

  • Meta-regression analysis of 20 randomized clinical trials (RCTs) involving 12,844 patients.
  • Event rates were analyzed to determine interactions between baseline clinical features and revascularization choice.

Main Results:

  • PCI significantly reduced stroke risk compared to CABG (30-day OR 0.36, follow-up OR 0.57).
  • Stroke reduction with PCI was more pronounced in female patients.
  • PCI was associated with higher repeat revascularization rates, especially in women and diabetic patients.

Conclusions:

  • PCI offers a significant stroke risk reduction over CABG, particularly beneficial for women.
  • The increased risk of repeat revascularization with PCI necessitates careful consideration, especially in female and diabetic populations.
Abstract

Keywords:
CABGMeta-regressionPCIStroke

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