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. 2024 Aug 30:18:11795468241274588.
doi: 10.1177/11795468241274588. eCollection 2024.

Influence of Previous Coronary Artery Bypass Grafting on Clinical Outcomes After Percutaneous Coronary Intervention: A Meta-Analysis of 250 684 Patients

Muhammad Omar Larik  1 , Ayesha Ahmed  2 , Abdul Rehman Shahid  1 , Hamza Irfan  3 , Areeka Irfan  4 , Muhammad Jibran  5
Affiliations

Influence of Previous Coronary Artery Bypass Grafting on Clinical Outcomes After Percutaneous Coronary Intervention: A Meta-Analysis of 250 684 Patients

Muhammad Omar Larik et al. Clin Med Insights Cardiol. .

Abstract

Background: Percutaneous coronary intervention (PCI), also known as coronary angioplasty, is the preferred strategy for treating obstructive coronary artery disease. Existing literature suggests the worsening of clinical outcomes in patients with previous coronary artery bypass grafting (CABG) history. In light of this, a comprehensive systematic review and meta-analysis was performed.

Methods: Databases including PubMed, Cochrane Library, and ScienceDirect were utilized for the inclusive systematic search dating from inception to September 01, 2023. The risk of bias assessment was performed using the Newcastle-Ottawa scale for cohort studies, and the Cochrane Risk of Bias Tool for randomized controlled trials.

Results: Ultimately, there were 16 eligible studies pooled together, involving a total of 250 684 patients, including 231 552 CABG-naïve patients, and 19 132 patients with a prior history of CABG. Overall, patients with CABG history were associated with significantly greater short-term mortality (P = .004), long-term mortality (P = .005), myocardial infarction (P < .00001), major adverse cardiovascular events (P = .0001), and procedural perforation (P < .00001). Contrastingly, CABG-naïve patients were associated with significantly greater risk of cardiac tamponade (P = .02) and repeat CABG (P = .03). No significant differences in stroke, bleeding, revascularization, or repeat PCI were observed.

Conclusion: Comparatively worsened clinical outcomes were observed, as patients with prior CABG history typically exhibit complex coronary anatomy, and have higher rates of comorbidities in comparison to their CABG-naïve counterparts. The refinement of current procedural and surgical techniques, in conjunction with continued research endeavors, are needed in order to effectively address this trend.

Keywords: CABG; PCI; Percutaneous coronary intervention; meta-analysis; previous coronary artery bypass grafting.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
The PRISMA flowchart illustrating the screening process.
Figure 2.
Figure 2.
Forest plot of short-term and long-term mortality.
Figure 3.
Figure 3.
Forest plot of postprocedural myocardial infarction (MI).
Figure 4.
Figure 4.
Forest plot of postprocedural major adverse cardiovascular events (MACE).
Figure 5.
Figure 5.
Forest plot of postprocedural stroke.
Figure 6.
Figure 6.
Forest plot of postprocedural bleeding.
Figure 7.
Figure 7.
Forest plot of revascularization.
Figure 8.
Figure 8.
Forest plot of postprocedural cardiac tamponade and procedural perforation.
Figure 9.
Figure 9.
Forest plot of repeat coronary artery bypass grafting (CABG) and repeat percutaneous coronary intervention (PCI).
See this image and copyright information in PMC

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