title: Influence of previous percutaneous coronary intervention on clinical outcome of coronary artery bypass grafting: a meta-analysis of comparative studies†.
abstract: The prognostic significance of previous percutaneous coronary intervention (PCI) in patients undergoing coronary artery bypass grafting (CABG) is still unclear. Although many studies have reported adverse effects of previous PCI on postoperative mortality in CABG, as yet no meta-analysis has been carried out. We conducted this first meta-analysis to assess whether previous PCI increases postoperative mortality in CABG. MEDLINE and EMBASE were searched for relevant articles up to and including April 2014. Studies published in English satisfying the following criteria were included in the meta-analysis: (i) comparing CABG patients with previous PCI versus without previous PCI; and (ii) reporting hospital mortality. Our search identified 23 comparative studies, including 174 777 patients: 19 179 with previous PCI and 155 598 without previous PCI. Pooled analysis demonstrated that previous PCI had an adverse effect on hospital mortality: odds ratio (OR) 1.187, 95% confidence interval (CI) 1.075-1.312. Furthermore, subgroup analysis stratified by the proportion of multiple previous PCI (i.e. number of patients with multiple previous PCI/number of patients with single or multiple previous PCI) was performed. In the subgroup of studies with the proportion <40%, the adverse effect was not significant: OR 0.897 (95% CI 0.723-1.113); however, in the subgroup of studies with the proportion ≥ 40%, the adverse effect of previous PCI was significant: OR 1.987 (95% CI 1.563-2.526). A meta-regression coefficient was significantly positive for the proportion of patients with a history of multiple PCI (coefficient 0.841; 95% CI 0.457-1.226; P < 0.001). This meta-analysis would argue that as the proportion of patients with multiple previous PCI in the CABG cohort increases, postoperative mortality also increases. This result re-emphasizes the importance of the heart team approach to coronary revascularization.
authors.affiliation: Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan uekichikara@gmail.com.
authors.forename: Chikara
authors.initials: C
authors.lastname: Ueki
authors.affiliation: Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan.
authors.forename: Genichi
authors.initials: G
authors.lastname: Sakaguchi
authors.affiliation: Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan.
authors.forename: Takehide
authors.initials: T
authors.lastname: Akimoto
authors.affiliation: Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan.
authors.forename: Tsunehiro
authors.initials: T
authors.lastname: Shintani
authors.affiliation: Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Ohashi
authors.affiliation: Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Sato
mesh_terms: D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Coronary artery bypass grafting; Meta-analysis; Percutaneous coronary intervention