Prognostic impact of prior percutaneous coronary intervention on patients undergoing coronary artery bypass grafting – A meta-analysis of reconstructed time-to-event data

Background

There is controversy on the effect of percutaneous coronary intervention (PCI) on outcomes of patients undergoing coronary artery bypass grafting (CABG). We meta-analytically assessed the prognostic impact of prior PCI in patients with coronary artery disease (CAD) who underwent CABG.

Methods

We performed a systematic review and meta-analysis of studies comparing patients who underwent CABG and had prior PCI in the past with patients who underwent CABG as primary treatment of CAD. Three databases were assessed. The primary endpoint was perioperative mortality. The secondary outcomes were long-term survival, perioperative myocardial infarction, neurological events, bleeding, acute renal failure, and hospital length of stay. Reconstruction of time-to-event data and pairwise meta-analysis were performed.

Results

Nineteen studies met the criteria for inclusion in the final analysis. Risk of perioperative mortality in patients undergoing CABG after a prior PCI was higher than in those undergoing primary CABG (OR: 1.16, 95 % CI, 1.03–1.31, p = 0.02). However, the prior PCI group presented higher survival rates when compared to the primary CABG group over the entire follow-up (HR: 0.90, 95 % CI, 0.86–0.94, p < 0.01). There was no significant difference between the groups regarding the other secondary outcomes.

Conclusions

When compared with patients who underwent CABG as primary treatment of CAD, prior PCI is associated with higher perioperative mortality for patients undergoing CABG. However, this increase in perioperative risk does not correlate with a decrease in long-term survival.