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. 2022 May 13:13:20406223221078755.
doi: 10.1177/20406223221078755. eCollection 2022.

Prior percutaneous coronary intervention and outcomes in patients after coronary artery bypass grafting: a meta-analysis of 308,284 patients

Hongliang Zhang  1 , Zhenyan Zhao  1 , Jing Yao  1 , Jie Zhao  1 , Tao Hou  2 , Moyang Wang  1 , Yanlu Xu  1 , Bincheng Wang  1 , Guannan Niu  1 , Yonggang Sui  1 , Guangyuan Song  3 , Yongjian Wu  4
Affiliations

Prior percutaneous coronary intervention and outcomes in patients after coronary artery bypass grafting: a meta-analysis of 308,284 patients

Hongliang Zhang et al. Ther Adv Chronic Dis. .

Abstract

Background: The association between prior percutaneous coronary intervention (PCI) and prognosis after coronary artery bypass grafting (CABG) remains uncertain. We aimed to evaluate the aforementioned association in a meta-analysis.

Methods: PubMed, Cochrane's Library, and Embase databases were searched for potential studies. A random-effects model was used for the meta-analysis. Meta-regression was performed to evaluate the influence of study characteristics on the outcomes.

Results: Thirty-six follow-up studies with 308,284 patients were included, and 40,892 (13.3%) patients had prior PCI. Pooled results showed that prior PCI was associated with higher risks of early (in-hospital or within 1 month) all-cause mortality [odds ratio (OR): 1.26, 95% confidence interval (CI): 1.11-1.44, p = 0.003; I 2 = 64%] and major adverse cardiovascular events (MACEs; OR: 1.36, 95% CI: 1.12-1.66, p = 0.002, I 2 = 79%), but not with late (follow-up durations from 1 to 13 years) mortality (OR: 1.03, 95% CI: 0.95-1.13, p = 0.44, I 2 = 46%) or MACEs (OR: 1.03, 95% CI: 0.97-1.09, p = 0.38, I 2 = 0%). Meta-regression showed that the study characteristics of patient number, age, sex, diabetic status, and proportion of patients with prior PCI did not affect the outcomes. Sensitivity analyses limited to multivariate studies excluding patients with acute PCI failure showed similar results (early mortality, OR: 1.25, p = 0.003; early MACE, OR: 1.50, p = 0.001; late mortality, OR: 1.03, p = 0.70).

Conclusion: The current evidence, mostly from retrospective observational studies, suggests that prior PCI is related to poor early clinical outcomes, but not to late clinical outcomes, after CABG.

Keywords: all-cause mortality; coronary artery bypass grafting; major adverse cardiovascular events; meta-analysis; percutaneous coronary intervention.

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Conflict of interest statement

Conflict of interest statement: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flowchart of database searches and study identification.
Figure 2.
Figure 2.
Forest plots for the meta-analysis of the associations between prior PCI and early outcomes after CABG: (a) early all-cause mortality and (b) early MACEs. CABG, coronary artery bypass grafting; CI, confidence interval; MACEs, major adverse cardiovascular events; PCI, percutaneous coronary intervention.
Figure 3.
Figure 3.
Forest plots for the meta-analysis of the associations between prior PCI and late outcomes after CABG: (a) late all-cause mortality and (b) late MACEs. CABG, coronary artery bypass grafting; CI, confidence interval; MACEs, major adverse cardiovascular events; PCI, percutaneous coronary intervention.
Figure 4.
Figure 4.
Sensitivity analyses including only multivariate studies without acute PCI failure: (a) early all-cause mortality; (b) early MACEs; and (c) late all-cause mortality. CI, confidence interval; MACEs, major adverse cardiovascular events; PCI, percutaneous coronary intervention.
Figure 5.
Figure 5.
Funnel plots for the meta-analysis of the associations between prior PCI and outcomes after CABG: (a) early all-cause mortality; (b) early MACEs; and (c) late all-cause mortality. CABG, coronary artery bypass grafting; MACEs, major adverse cardiovascular events; PCI, percutaneous coronary intervention.
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