A Systematic Review and Meta-Analysis of Percutaneous Coronary Intervention (PCI) and Coronary Bypass Grafting (CABG) Outcomes in Indigenous vs. Non-Indigenous Australians

Abstract

Introduction: A major cause of death, coronary artery disease (CAD) often necessitates invasive procedures like coronary bypass grafting (CABG) and percutaneous coronary intervention (PCI). Cardiovascular outcomes vary between indigenous and non-indigenous Australian people; however, comprehensive knowledge of these differences is absent.

Methodology: To compare PCI and CABG results between indigenous and non-indigenous Australians, a systematic review and meta-analysis were carried out. Included were 10 retrospective observational studies that examined mortality, cardiovascular events, comorbidities, and operative success rates. Databases spanning 2014 to 2024 were searched, and research that directly compared Australia's indigenous and non-indigenous populations was among the inclusion criteria.

Results: Within 30 days of surgery, indigenous Australians receiving PCI had greater rates of comorbidities and were at higher risk of long-term mortality and MACE. Similarly, there was a greater long-term death rate among indigenous patients following CABG. Cultural safety, socioeconomic factors, and regional factors affecting treatment delays and access to care all affected disparities. For 30-day mortality, the pooled analysis shows an odds ratio of 1.04 (95% CI 0.78, 1.40), indicating no meaningful difference. The total odds ratio for unfavorable occurrences is 1.07 (95% CI 0.86, 1.33), meaning there is no statistically significant difference between Indigenous groups and those that are not.

Conclusion: Indigenous Australians continue to have worse cardiovascular outcomes after PCI and CABG procedures, even with similar procedural success rates. To ensure equitable cardiovascular outcomes for indigenous groups, targeted therapies targeting underlying risk factors, increased access to culturally appropriate care, and decreased obstacles to healthcare access are critical.

Keywords: coronary artery bypass grafting(cabg); indigenous; major adverse cardiac effect (mace); primary pci; systematic review and meta analysis.