Contemporary clinical trials · 2014
Percutaneous coronary intervention versus coronary artery bypass graft for stable angina: meta-regression of randomized trials.
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D'Ascenzo Fabrizio, Barbero Umberto, Moretti Claudio, Palmerini Tullio, Della Riva Diego, Mariani Andrea, Omedè Pierluigi, DiNicolantonio James J, Biondi-Zoccai Giuseppe, Gaita Fiorenzo
Аннотация
AIMS: Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) perform similarly in terms of lowering mortality and myocardial infarction rates in patients with stable angina, except in subjects with high-risk lesions. PCI is burdened from higher rates of revascularization, but offers a reduction in stroke. To date, the impact of clinical variables on the risk-benefit assessment has not been established.
METHODS AND RESULTS: Using event rates as a dependent variable, meta-regression was performed to test whether an interaction existed between baseline clinical features (age, gender, diabetes mellitus, previous myocardial infarction and ejection fraction) and choice of revascularization, focusing on death, myocardial infarction, repeat revascularization and stroke. 20 randomized clinical trials (RCT) including 12,844 patients with stable angina were included. Compared to CABG, PCI significantly reduced the risk of stroke, both at 30 days (odds ratio [OR] 0.36 [95% confidence interval: 0.20-0.62]) and at follow up (median=12 months, OR=0.57 [0.41-0.80]). This reduction in stroke was significantly higher in females (B=-0.12, p=0.03). For repeat revascularization, PCI performed worse than CABG, both in the overall population and in patients with multivessel disease (OR=4.71 [3.17-7.01]) and (OR=7.18 [4.32-11.93]). Women (B=3.4, p=0.01) and those with diabetes mellitus (B=1.8, p=0.002) were at increased risk of subsequent revascularization after PCI.
CONCLUSION: PCI significantly reduces the risk of stroke compared to CABG particularly in female patients: however the risk of revascularization is increased with PCI, especially in women and in those with diabetes.
METHODS AND RESULTS: Using event rates as a dependent variable, meta-regression was performed to test whether an interaction existed between baseline clinical features (age, gender, diabetes mellitus, previous myocardial infarction and ejection fraction) and choice of revascularization, focusing on death, myocardial infarction, repeat revascularization and stroke. 20 randomized clinical trials (RCT) including 12,844 patients with stable angina were included. Compared to CABG, PCI significantly reduced the risk of stroke, both at 30 days (odds ratio [OR] 0.36 [95% confidence interval: 0.20-0.62]) and at follow up (median=12 months, OR=0.57 [0.41-0.80]). This reduction in stroke was significantly higher in females (B=-0.12, p=0.03). For repeat revascularization, PCI performed worse than CABG, both in the overall population and in patients with multivessel disease (OR=4.71 [3.17-7.01]) and (OR=7.18 [4.32-11.93]). Women (B=3.4, p=0.01) and those with diabetes mellitus (B=1.8, p=0.002) were at increased risk of subsequent revascularization after PCI.
CONCLUSION: PCI significantly reduces the risk of stroke compared to CABG particularly in female patients: however the risk of revascularization is increased with PCI, especially in women and in those with diabetes.