Prior Percutaneous Coronary Interventions May Be Associated With Increased Mortality After Coronary Bypass Grafting:...

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology

Background:

• Conflicting evidence exists regarding adverse outcomes after coronary artery bypass surgery (CABG) in patients with prior percutaneous intervention (PCI).
• Understanding the impact of prior PCI on CABG outcomes is crucial for patient management and surgical planning.

Purpose of the Study:

• To synthesize existing evidence on the association between prior PCI and outcomes following CABG.
• To evaluate the effects of prior PCI on survival, major adverse cardiovascular events (MACE), and myocardial infarction.

Main Methods:

• A comprehensive literature search was conducted for studies published between 1998 and 2017.
• Meta-analysis techniques, including forest plots and funnel plots, were used to analyze data from 31 studies involving over 218,000 patients.
• Outcomes assessed included survival, MACE, and myocardial infarction, with both unmatched and propensity-matched data analyzed.

Main Results:

• Prior PCI did not significantly affect overall survival after CABG (inverse rate ratio: 1.12, P=0.110).
• However, patients with prior PCI experienced significantly worse MACE rates (odds ratio: 1.26, P=0.03).
• The relative risk of mortality associated with prior PCI has decreased over the past two decades, though high institutional PCI rates correlated with higher mortality.

Conclusions:

• Current evidence suggests that undergoing PCI before CABG does not adversely affect patient survival.
• Despite improved survival, prior PCI is associated with increased early and late MACE.
• High rates of prior PCI within an institution may be linked to increased CABG-associated mortality, warranting further investigation.