Could clinical variables of patients undergoing surgical or percutaneous coronary revascularization be useful to make a better choiche? a meta-regression of randomized clinical trials

Purpose: Coronary artery disease represents the most important cause of death in the world. Surgical and percutaneous revascularization are the two main options for these patients: the presence of two available strategies offers physicians the opportunity/challenge of a choice, but their possible interactions with patient's characteristics both on risk (stroke) and on benefit (reduction death, myocardial infarction and revascularization) has not yet been assessed. Methods: A meta-regression was performed to test whether an interaction between baseline clinical features (age, gender, diabetes mellitus, previous myocardial infarction and ejection fraction) and revascularization choice was present. Death, myocardial infarction, repeat revascularization and stroke were taken as outcomes. Results: We included 19 RCTs with 10.944 patients. PCI significantly reduces risk of stroke, both at 30 days (0.36 [0.20,0.62]) and at follow up of a median of 12.1 months (0.59 [0.38,0.93]). Female gender offers a significant benefit if PCI was performed (Beta=-0.12; p=0.03). Regarding the need for repeated revascularization, PTCA performes worse than CABG, both in overall population and in patients with multivessel disease (OR=4.89 [3.20, 7.47] and 7.18 [4.32,11.93]; all CI=95%). Conclusions: PCI reduces the risk of developing stroke after coronary revascularization, especially in women, but it is also associated with a higher probability to perform a new revascularization procedure, mostly in women and diabetic patients. No baseline patient's feature affects differences regarding death or myocardial infarction.