Key result
Prior CABG is linked to higher MACE and mortality versus CABG-naïve patients undergoing PCI.
Why the study?
Existing literature suggests worsening clinical outcomes in patients with previous CABG undergoing PCI, necessitating a comprehensive systematic review and meta-analysis.
Does a history of previous coronary artery bypass grafting worsen clinical outcomes in patients undergoing percutaneous coronary intervention?
Meta-Analysis (n=250,684)
Does a history of previous coronary artery bypass grafting worsen clinical outcomes in patients undergoing percutaneous coronary intervention?
p-value: p=.0001
Patients with a history of CABG undergoing PCI have significantly worse clinical outcomes, including higher mortality and MACE, compared to CABG-naïve patients.
Prior CABG identifies higher-risk PCI patients for closer monitoring; extends meta-analytic evidence on adverse outcomes in this subgroup.
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.
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Larik et al. (2024) conducted a meta-analysis in Obstructive coronary artery disease (n=250,684). Previous coronary artery bypass grafting (CABG) vs. CABG-naïve was evaluated on Major adverse cardiovascular events (p=.0001). In patients undergoing PCI, a prior history of CABG was associated with significantly greater major adverse cardiovascular events (P=0.0001) and mortality compared to CABG-naïve patients.
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