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Late Myocardial Infarction and Repeat Revascularization after Coronary Artery Bypass Grafting in Patients with Prior Percutaneous Coronary Intervention. J Clin Med 2022; 11:jcm11195755. [PMID: 36233623 PMCID: PMC9570994 DOI: 10.3390/jcm11195755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives: The aim of the present study was to evaluate the risk of late mortality and major adverse cardiovascular and cerebral events after coronary artery bypass grafting (CABG) in patients with prior percutaneous coronary intervention (PCI). Methods: A total of 2948 patients undergoing isolated CABGs were included in a prospective multicenter registry. Outcomes were adjusted for multiple covariates in logistic regression, Cox proportional hazards analysis and competing risk analysis. Results: In all, 2619 patients fulfilled the inclusion criteria of this analysis. Of them, 2199 (79.1%) had no history of PCI and 420 (20.9%) had a prior PCI. An adjusted analysis showed that a single prior PCI and multiple prior PCIs did not increase the risk of 30-day and 5-year mortality. Patients with multiple prior PCIs had a significantly higher risk of 5-year myocardial infarction (SHR 2.566, 95%CI 1.379–4.312) and repeat revascularization (SHR 1.774, 95%CI 1.140–2.763). Similarly, 30-day and 5-year mortality were not significantly increased in patients with prior PCI treatment of single or multiple vessels. Patients with multiple vessels treated with PCI had a significantly higher risk of 5-year myocardial infarction (SHR 2.640, 95%CI 1.497–4.658), repeat revascularization (SHR 1.648, 95%CI 1.029–2.638) and stroke (SHR 2.215, 95%CI 1.056–4.646) at 5-year. The risk for repeat revascularization was also increased with a prior single vessel PCI, but not for other outcomes. Conclusions: Among patients undergoing CABGs, multiple prior PCIs seem to increase the risk of late myocardial infarction and the need for repeat revascularization, but not the risk of mortality.
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Zhang H, Zhao Z, Yao J, Zhao J, Hou T, Wang M, Xu Y, Wang B, Niu G, Sui Y, Song G, Wu Y. Prior percutaneous coronary intervention and outcomes in patients after coronary artery bypass grafting: a meta-analysis of 308,284 patients. Ther Adv Chronic Dis 2022; 13:20406223221078755. [PMID: 35586304 PMCID: PMC9109498 DOI: 10.1177/20406223221078755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/20/2022] [Indexed: 12/02/2022] Open
Abstract
Background: The association between prior percutaneous coronary intervention (PCI) and
prognosis after coronary artery bypass grafting (CABG) remains uncertain. We
aimed to evaluate the aforementioned association in a meta-analysis. Methods: PubMed, Cochrane’s Library, and Embase databases were searched for potential
studies. A random-effects model was used for the meta-analysis.
Meta-regression was performed to evaluate the influence of study
characteristics on the outcomes. Results: Thirty-six follow-up studies with 308,284 patients were included, and 40,892
(13.3%) patients had prior PCI. Pooled results showed that prior PCI was
associated with higher risks of early (in-hospital or within 1 month)
all-cause mortality [odds ratio (OR): 1.26, 95% confidence interval (CI):
1.11–1.44, p = 0.003; I2 = 64%]
and major adverse cardiovascular events (MACEs; OR: 1.36, 95% CI: 1.12–1.66,
p = 0.002, I2 = 79%), but
not with late (follow-up durations from 1 to 13 years) mortality (OR: 1.03,
95% CI: 0.95–1.13, p = 0.44,
I2 = 46%) or MACEs (OR: 1.03, 95% CI: 0.97–1.09,
p = 0.38, I2 = 0%).
Meta-regression showed that the study characteristics of patient number,
age, sex, diabetic status, and proportion of patients with prior PCI did not
affect the outcomes. Sensitivity analyses limited to multivariate studies
excluding patients with acute PCI failure showed similar results (early
mortality, OR: 1.25, p = 0.003; early MACE, OR: 1.50,
p = 0.001; late mortality, OR: 1.03,
p = 0.70). Conclusion: The current evidence, mostly from retrospective observational studies,
suggests that prior PCI is related to poor early clinical outcomes, but not
to late clinical outcomes, after CABG.
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Affiliation(s)
- Hongliang Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhenyan Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Yao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Hou
- Department of Cardiology, Cixian People's Hospital, Han Dan City, China
| | - Moyang Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanlu Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bincheng Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guannan Niu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yonggang Sui
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guangyuan Song
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Anzhen road 2, Chaoyang District, Beijing 100029, China
| | - Yongjian Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China
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