Prior Coronary Artery Bypass Grafting and Its Impact on Lesion Complexity, Procedural Characteristics, and Outcomes in Chronic Total Occlusion Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

Prior coronary artery bypass grafting (CABG) is associated with accelerated native vessel atherosclerosis and more complex chronic total occlusion (CTO) anatomy, rendering CTO-percutaneous coronary intervention (PCI) more challenging despite contemporary technical advances. We performed a systematic review and meta-analysis to compare CTO lesion characteristics, procedural demands, and in-hospital outcomes according to prior CABG status. PubMed, the Cochrane Library, and Google Scholar were systematically searched from inception through May 15, 2026, for studies comparing CTO-PCI outcomes in patients with and without prior CABG. Data were pooled using odds ratios (ORs) and standardized mean differences (SMDs). Twelve studies enrolling 47,434 patients, including 10,354 with prior CABG, were included. Compared with patients without prior CABG, those with prior CABG had higher rates of blunt stump morphology (OR 1.51 [1.42–1.61]), proximal cap ambiguity (OR 1.55 [1.45–1.66]), calcification (OR 2.49 [2.22–2.79]), vessel bending (OR 2.27 [1.27–4.05]), distal cap bifurcation (OR 1.73 [1.51–1.98]), and higher Multicenter CTO Registry of Japan scores (SMD 0.48 [0.40–0.56]). Procedural burden was greater, with higher contrast use, longer fluoroscopy time and procedure duration, and greater stent use. Technical success (OR 0.63 [0.43–0.92]) and procedural success (OR 0.60 [0.53–0.69]) were lower in the prior CABG group. In-hospital mortality (OR 2.19), myocardial infarction (OR 2.29), and contrast-induced nephropathy (OR 1.97) were higher, whereas cardiac tamponade was less frequent (OR 0.37). Prior CABG is associated with substantially greater CTO complexity, procedural burden, and in-hospital risk, underscoring the need for careful procedural planning and individualized risk stratification in this population.