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

Hongliang Zhang; Zhenyan Zhao; Jing Yao; Jie Zhao; Tao Hou; Moyang Wang; Yanlu Xu; Bincheng Wang; Guannan Niu; Yonggang Sui; Guangyuan Song; Yongjian Wu

doi:10.1177/20406223221078755

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

Ther Adv Chronic Dis. 2022 May 13:13:20406223221078755. doi: 10.1177/20406223221078755. eCollection 2022.

Authors

Affiliations

¹ Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Cardiology, Cixian People's Hospital, Han Dan City, China.
³ Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Anzhen road 2, Chaoyang District, Beijing 100029, China.
⁴ Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China.

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.