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Updated: Apr 15, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Coronary Artery Bypass Grafting After Percutaneous Intervention Has Higher Early Mortality: A Meta-Analysis
Salah E Altarabsheh1, Salil V Deo1, Dustin Hang2
1Department of Cardiovascular Surgery, Queen Alia Heart Institute, Amman, Jordan.
Insights
Primary coronary artery bypass grafting (CABG) shows lower early mortality and myocardial infarction compared to secondary CABG after percutaneous intervention. Midterm survival remains comparable between the two groups.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Health Services Research
Background:
- Limited data exists comparing early adverse events and midterm survival between primary coronary artery bypass grafting (pCABG) and secondary CABG (sCABG) following percutaneous intervention.
- Understanding these differences is crucial for optimizing patient care pathways.
Purpose of the Study:
- To systematically compare early adverse events and midterm survival rates between patients undergoing pCABG and sCABG.
- To provide evidence-based insights for clinical decision-making in revascularization strategies.
Main Methods:
- A systematic review of published literature was conducted to identify relevant original studies.
- A random-effect inverse variance weighted analysis was performed on endpoints including early mortality, stroke, renal failure, myocardial infarction, and intra-aortic balloon pump use.
- Results were presented as risk ratios with 95% confidence intervals, with statistical significance set at p < 0.05.
Main Results:
- Fourteen studies involving 84,983 pCABG patients and 14,775 sCABG patients were analyzed.
- pCABG was associated with significantly lower early mortality (RR 1.54 [1.19-2]; p=0.007) and a trend towards less myocardial infarction (RR 1.46 [1.04-2.06]; p=0.06).
- Renal failure was also lower with pCABG (RR 1.254 [1.047-1.502]; p=0.014), while stroke rates were comparable (p=0.95).
- Midterm survival at 3 years was comparable between the pCABG and sCABG cohorts (p=0.36).
Conclusions:
- Patients undergoing CABG after prior percutaneous intervention (sCABG) experience a higher incidence of postoperative myocardial infarction and mortality.
- Despite increased early risks, midterm survival outcomes are similar for both primary CABG and secondary CABG patients.
- These findings highlight the importance of considering procedural risks and long-term outcomes when selecting revascularization strategies.
Background:
We compared early adverse events and midterm survival between primary coronary artery bypass grafting (pCABG) and CABG in patients with percutaneous intervention (secondary CABG, sCABG) because data on this topic are very limited.
Methods:
A systematic review of published literature was done to obtain original studies fulfilling the search criteria. The end points studied were early mortality, stroke, renal failure, myocardial infarction, and the need for an intra-aortic balloon pump. A random-effect inverse variance weighted analysis was performed. The results are presented as risk ratios (RR) (95% confidence interval); p < 0.05 was considered statistically significant.
Results:
Fourteen studies (84,983 pCABG patients and 14,775 sCABG patients) were included in the systematic review. Early mortality was lower with primary CABG (RR 1.54 [1.19-2]; p = 0.007). The incidence of myocardial infarction was also less with pCABG than with sCABG. (RR 1.46 [1.04-2.06]; p = 0.06). Patients undergoing pCABG were 14% (0% to 55%; p = 0.04). Less likely to need an intra-aortic balloon pump. Although renal failure was lower with pCABG (RR 1.254 [1.047-1.502]; p = 0.014), the stroke rates were comparable in both cohorts (p = 0.95). Renal failure was favorable in the primary CABG cohort. Early stroke was comparable between the two cohorts (p = 0.95). The pooled hazard ratios demonstrated comparable survival at the end of 3 years (p = 0.36).
Conclusions:
Patients undergoing CABG after prior percutaneous therapy have a higher incidence of myocardial infarction and mortality in the postoperative period. However, midterm survival is comparable in both cohorts.
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