Coronary Artery Bypass Grafting After Percutaneous Intervention Has Higher Early Mortality: A Meta-Analysis (original) (raw)
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2016
Objectives: To quantify the incidence of major adverse events (AEs) occurring in hospital or within 30 days after surgery in patients undergoing coronary artery bypass graft (CABG) surgery and to identify risk factors for these AEs. Methods: Systematic review and analysis of studies published in English since 1990. Studies of iso-lated standard CABG reporting postoperative incidence of myocardial infarction (MI), stroke, gastro-intestinal bleeding, renal failure, or death in hospital or within 30 days were eligible for inclusion. Incidence of these events was calculated overall and for selected patient groups defined by all elective CABG versus mixed (some non-elective); mean ejection fraction < 50 % versus> 50%; mean age < 60 versus> 60 years; primary CABG versus some reoperations; randomised controlled trials versus cohort studies; and single centre versus multicentre studies. Odds ratios of selected AEs were computed according to group risk factors. Results: 176 studi...
2021
Background: Coronary artery disease (CAD) is a major cause of death in developed countries, and this disease is diagnosed in an increasing number of adults nowadays, particularly among young patients Aims: The study aims to compare the differences in the early outcomes of patients undergoing Coronary Artery Bypass Grafting (CABG) who had prior Percutaneous Transluminal Coronary Angioplasty versus those who have not. Materials and methods: Perioperative outcome of CABG (Coronary Artery Bypass Grafting) in patients with or without primary PCI (Percutaneous Coronary Intervention) single institute a retrospective and prospective study of 100 cases during the period of 2016 to 2020. Results: The EuroScore in PCI group is higher than the Non PCI group undergoing CABG and difference was found to be statistical significance. The need for post surgery IABP was higher in Non PCI group. ICU stay the patient in Non PCI had lower ICU stay then PCI group which is having statistical significance. The mortality was higher in Non PCI group compare to PCI group but not statistical significance. Conclusions: In conclusion, CABG remains the best revascularization strategy in MVD(Multi vessel Disease), conferring reduced mortality and repeat revascularization risk. The absolute risk increases in stroke associated with CABG does not outweigh the benefit in the long-term survival achievable with this technique of revascularization.
Circulation. Cardiovascular interventions, 2018
The clinical impact of prior percutaneous coronary intervention (PCI) in patients requiring coronary artery bypass grafting (CABG) remains unsettled. We sought to determine whether prior PCI is associated with adverse outcome after CABG. Data from the prospective E-CABG (European Multicenter Study on Coronary Artery Bypass Grafting) conducted between January 2015 and March 2016 at 16 European centres were analyzed using propensity weighted methodology to adjust for confounding. A parallel systematic review/meta-analysis (MEDLINE, Embase, SCOPUS, and Cochrane Library) through September 2017 was accomplished. Of a total of 3641 adult patients included in the E-CABG study, 685 (19%) patients had a history of PCI. At multivariable level, prior PCI was not associated with an increased hospital mortality in both unweighted and weighted patient groups (odds ratio, 0.73; 95% confidence interval, 0.29-1.38;=0.33 and odds ratio, 0.90; 95% confidence interval, 0.39-2.08;=0.81, respectively). S...
Current Clinical Outcomes of Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting
The Annals of Thoracic Surgery, 2008
Background. Randomized trials have compared coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). However, results of these trials in select patients may not accurately reflect current clinical practice using drug-eluting stents (DES) and off-pump CABG. We undertook a prospective registry of coronary revascularization by CABG on-pump and offpump, and PCI with or without DES, to determine clinical outcomes. Methods. All patients undergoing isolated coronary revascularization in 8 community-based hospitals were enrolled. Preprocedural, intraprocedural, and postprocedural data were captured, with outcomes obtained at 18 months by patient and physician contact, and the Social Security Death Index. Results. The study enrolled 4336 patients, 71.2% PCI and 28.8% CABG. DESs were used in 2249 PCIs (73.1%), and 596 CABG procedures (47.8%) were off-pump. Incidence of major adverse cardiac events at 18 months was 14.7% for CABG vs 23.3% for PCI (p < 0.001). Cardiac death and myocardial infarction had similar rates. The need for repeat revascularization was significantly less with CABG (6.2% vs 13.6%, p < 0.001). Hazard ratio of CABG to PCI was 0.76 (95% confidence interval, 0.571 to 0.872). CABG outcome was similar on-pump and offpump, as was repeat revascularization with DES (12.1%) vs BMS (14.9%; p ؍ 0.096). Overall event-free survival was 85.3% in CABG and 76.8% in PCI (p < 0.001). Conclusions. Rates of repeat revascularization were significantly higher for PCI than for CABG, but mortality and myocardial infarction were the same. There were no significant differences in outcomes between DES and BMS or between on-pump and off-pump CABG.
Lancet (London, England), 2018
Numerous randomised trials have compared coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) for patients with coronary artery disease. However, no studies have been powered to detect a difference in mortality between the revascularisation strategies. We did a systematic review up to July 19, 2017, to identify randomised clinical trials comparing CABG with PCI using stents. Eligible studies included patients with multivessel or left main coronary artery disease who did not present with acute myocardial infarction, did PCI with stents (bare-metal or drug-eluting), and had more than 1 year of follow-up for all-cause mortality. In a collaborative, pooled analysis of individual patient data from the identified trials, we estimated all-cause mortality up to 5 years using Kaplan-Meier analyses and compared PCI with CABG using a random-effects Cox proportional-hazards model stratified by trial. Consistency of treatment effect was explored in subgroup analys...
The Annals of Thoracic Surgery, 2010
We performed a meta-analysis of all studies comparing offpump coronary artery bypass graft surgery (OPCABG) and percutaneous coronary intervention (PCI) for patients with coronary artery disease. Ten studies were included in the meta-analysis and 4,821 patients were compared, of whom 3,450 patients underwent PCI and 1,371 patients underwent OPCABG. The rates of stroke, myocardial infarction, cardiac mortality, and all-cause mortality were similar. The 12-month rate of major adverse cardiac or cerebrovascular events and need for repeat revascularization was significantly lower in the OPCABG group when compared with the PCI group.
2014
In this study we compare the factors affecting mortality and morbidity of the patients had coronary artery bypass graft (CABG) with/without percutaneous coronary intervention (PCI) prior to the CABG operation. Patients and Methods: In our study a total of 214 patients who underwent CABG in our hospital between January 2006-2008 were included. They were divided into two groups as A and B. In group A, 135 patients in whom CABG was performed after PCI (mean age 52.5±8.8 years) were included; in group B, 79 patients in whom CABG was performed without any coronary intervention (mean age 51.8±8.8 years) were included. Both groups were evaluated in terms of demographic characteristics, comorbid diseases and medications, preoperative ejection fraction (EF) and functional capacity, durations of preoperative cardiopulmonary bypass (CPB) and cross clamp, number of distal bypass, whether bypass was performed on the coronary artery undergoing PCI, inotropic agent or intra-aortic balloon pump support at the time of referring to postoperative intensive care unit (ICU), duration of postoperative ICU stay and complications. Results: Of the patients, 85% were males and 15% were females. In 73% (n=98) of the patients undergoing CABG following PCI, bypass was performed also on the artery undergoing PCI. The rate of malignant arrhythmia was higher in the group A in which CABG was performed following PCI as compared to the group B (8% (n=11) in the group A, 1% (n=1) in the group B). The rate of development of cerebrovascular event (CVE) was 4% (n=5) in the group A and 1% (n=1) in the group B. Postoperative mortality was 15% (n=22) in the group A and 3% (n=2) in the group B. Conclusion: Although PCI may be a life-saving procedure in patients presenting with acute myocardial infarction, some serious complications may occur during the procedure. So an urgent surgical intervention may be necessary. In this study, mortality and morbidity of the CABG procedures performed after PCI are reported to be high.