Prior Percutaneous Coronary Interventions May Be Associated With Increased Mortality After Coronary Bypass Grafting: A Meta-Analysis.

Autor: Luthra S; Southampton University Hospitals, Southampton, United Kingdom. Electronic address: drsl00@gmail.com., Leiva-Juárez MM; Department of Surgery, Brookdale University Hospital and Medical Center, Brooklyn, New York., Shine B; University of Oxford, Oxford, United Kingdom., Al-Attar N; Golden Jubilee National Hospital, Glasgow, United Kingdom., Ohri S; Southampton University Hospitals, Southampton, United Kingdom., Taggart DP; University of Oxford, Oxford, United Kingdom.
Jazyk: angličtina
Zdroj: Seminars in thoracic and cardiovascular surgery [Semin Thorac Cardiovasc Surg] 2020 Spring; Vol. 32 (1), pp. 59-74. Date of Electronic Publication: 2019 Sep 23.
DOI: 10.1053/j.semtcvs.2019.09.009
Abstrakt: There is conflicting evidence for adverse outcomes after coronary artery bypass surgery (CABG) with prior percutaneous intervention (PCI). A literature search was performed from 1998 to 2017 and articles with primary or secondary outcomes of survival, major adverse cardiovascular events (MACE), and myocardial infarction in CABG patients with prior PCI were included. Forest plots were generated from odds ratios for survival, MACE, and myocardial infarction for unmatched and propensity-matched data. Heterogeneity between studies was assessed for all outcomes using I 2 . Funnel plots were generated for early survival, survival at 5 years, survival at >5 years, and MACE. Thirty-one studies were included over 18 years with 194,544 patients without PCI prior to CABG and 23,519 patients (12.09%) with prior PCI. Prior PCI did not adversely affect survival among the included studies (inverse rate ratio: 1.12, 95% confidence interval: 0.98-1.27, P = 0.110. MACE was significantly worse for those with prior PCI (odds ratio: 1.26, confidence interval: 1.02-1.55, P = 0.03). The relative risk of mortality associated with prior PCI has decreased significantly over the last 2 decades. Studies with higher percentage of prior PCI patients had higher relative mortalities. There was significant heterogeneity between studies for the treatment effects. PCI prior to CABG in recent times does not adversely affect survival despite adverse early and late MACE rates. However, high institutional rates of prior PCI may be associated with increasing mortality after CABG.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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