Meta-analysis Comparing Outcomes of Percutaneous Coronary Intervention of Native Artery Versus Bypass Graft in Patients With Prior Coronary Artery Bypass Grafting

Percutaneous coronary intervention (PCI) is common in patients with prior coronary artery bypass graft surgery (CABG), however the data on the association between the PCI target-vessel and clinical outcomes are not clear. We aimed to investigate long-term clinical outcomes of patients with prior CAB...

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Published in:The American journal of cardiology 2021-02, Vol.140, p.47-54
Main Authors: Farag, Mohamed, Gue, Ying X., Brilakis, Emmanouil S., Egred, Mohaned
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Angioplasty
Bias
Bleeding
Blood vessels
Cerebral infarction
Clinical outcomes
Confidence intervals
Coronary artery
Coronary Artery Bypass - methods
Coronary Artery Disease - surgery
Coronary vessels
Diabetes
Global Health
Graft Occlusion, Vascular - epidemiology
Graft Occlusion, Vascular - prevention & control
Graft rejection
Grafting
Grafts
Heart attacks
Heart surgery
Humans
Incidence
Intervention
Meta-analysis
Mortality
Myocardial infarction
Observational Studies as Topic
Patients
Percutaneous Coronary Intervention - methods
Reoperation
Stents
Stroke
Veins & arteries
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description Percutaneous coronary intervention (PCI) is common in patients with prior coronary artery bypass graft surgery (CABG), however the data on the association between the PCI target-vessel and clinical outcomes are not clear. We aimed to investigate long-term clinical outcomes of patients with prior CABG who underwent PCI of either bypass graft or native artery. We performed a systematic review and meta-analysis of observational studies comparing PCI of either bypass graft or native artery in patients with prior CABG. Twenty-two studies comprising 40,984 patients were included. The median follow-up duration was 2 (1 to 3) years. Compared with bypass graft PCI, native artery PCI was frequent (61% vs 39%) and was associated with lower major adverse cardiac events (MACE) (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.45 to 0.57, p
doi_str_mv 10.1016/j.amjcard.2020.10.062
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We aimed to investigate long-term clinical outcomes of patients with prior CABG who underwent PCI of either bypass graft or native artery. We performed a systematic review and meta-analysis of observational studies comparing PCI of either bypass graft or native artery in patients with prior CABG. Twenty-two studies comprising 40,984 patients were included. The median follow-up duration was 2 (1 to 3) years. Compared with bypass graft PCI, native artery PCI was frequent (61% vs 39%) and was associated with lower major adverse cardiac events (MACE) (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.45 to 0.57, p &lt;0.001), lower all-cause death (OR 0.65, 95% CI 0.49 to 0.87, p = 0.004), lower myocardial infarction (OR 0.56, 95% CI 0.45 to 0.69, p &lt;0.001), and lower target vessel revascularization (TVR) (OR 0.62, 95% CI 0.51to 0.76, p &lt;0.001). There was no significant difference in the early incidence of major bleeding or stroke between the 2 cohorts. In 6 studies involving 2,919 patients with ST-elevation myocardial infarction, there was no significant differences between the 2 cohorts. The increase in TVR risk with bypass graft PCI was associated with MACE. In conclusion, in observational studies involving patients with prior CABG, native artery PCI was associated with lower MACE, all-cause death, myocardial infarction, and TVR compared with bypass graft PCI at a median follow-up of 2 years. 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subjects Acute coronary syndromes
Angioplasty
Bias
Bleeding
Blood vessels
Cerebral infarction
Clinical outcomes
Confidence intervals
Coronary artery
Coronary Artery Bypass - methods
Coronary Artery Disease - surgery
Coronary vessels
Diabetes
Global Health
Graft Occlusion, Vascular - epidemiology
Graft Occlusion, Vascular - prevention & control
Graft rejection
Grafting
Grafts
Heart attacks
Heart surgery
Humans
Incidence
Intervention
Meta-analysis
Mortality
Myocardial infarction
Observational Studies as Topic
Patients
Percutaneous Coronary Intervention - methods
Reoperation
Stents
Stroke
Veins & arteries
title Meta-analysis Comparing Outcomes of Percutaneous Coronary Intervention of Native Artery Versus Bypass Graft in Patients With Prior Coronary Artery Bypass Grafting
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