title: Percutaneous coronary intervention versus coronary artery bypass graft for stable angina: meta-regression of randomized trials.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Cardiology, University of Turin, Italy; Meta-analysis and Evidence based medicine Training in Cardiology (METCARDIO), Italy. Electronic address: fabrizio.dascenzo@gmail.com.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.affiliation: Division of Cardiology, University of Turin, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Barbero
authors.affiliation: Division of Cardiology, University of Turin, Italy; Meta-analysis and Evidence based medicine Training in Cardiology (METCARDIO), Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.affiliation: Division of Cardiology, University of Bologna, Italy.
authors.forename: Tullio
authors.initials: T
authors.lastname: Palmerini
authors.affiliation: Division of Cardiology, University of Bologna, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Della Riva
authors.affiliation: Division of Cardiology, University of Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mariani
authors.affiliation: Division of Cardiology, University of Turin, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Omedè
authors.affiliation: Mid America Heart Institute at Saint Luke's Hospital, Kansas City, MO, United States.
authors.forename: James J
authors.initials: JJ
authors.lastname: DiNicolantonio
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Italy; Sapienza University of Rome, Latina, Italy; Meta-analysis and Evidence based medicine Training in Cardiology (METCARDIO), Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.affiliation: Division of Cardiology, University of Turin, Italy.
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D000367:Age Factors; D060050:Angina, Stable / Q000453:epidemiology / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000453:epidemiology; D006801:Humans; D009203:Myocardial Infarction / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke; D013318:Stroke Volume
keywords: CABG; Meta-regression; PCI; Stroke