Key result
Prior PCI was associated with higher risks of early all-cause mortality (OR 1.26; 95% CI 1.11-1.44; p=0.003) and early MACEs after CABG, but not with late mortality or MACEs.
Why the study?
The association between prior percutaneous coronary intervention (PCI) and prognosis after coronary artery bypass grafting (CABG) remains uncertain.
Does prior PCI worsen early and late clinical outcomes in patients undergoing subsequent CABG?
Meta-Analysis (n=308,284)
Does prior PCI worsen early and late clinical outcomes in patients undergoing subsequent CABG?
Odds Ratio: 1.26 (95% CI 1.11–1.44)
p-value: p=0.003
Prior PCI is associated with worse early clinical outcomes, but not late outcomes, in patients undergoing subsequent CABG.
Patients with prior PCI warrant heightened early post-CABG vigilance; observational meta-analysis leaves open independent causal effects on prognosis.
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.
No takes yet. Share an insight, caveat, or question.
Zhang et al. (2022) conducted a meta-analysis in Coronary artery bypass grafting (CABG) (n=308,284). Prior percutaneous coronary intervention (PCI) vs. No prior PCI was evaluated on Early (in-hospital or within 1 month) all-cause mortality (OR 1.26, 95% CI 1.11-1.44, p=0.003). Prior PCI was associated with higher risks of early all-cause mortality (OR 1.26; 95% CI 1.11-1.44; p=0.003) and early MACEs after CABG, but not with late mortality or MACEs.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: