Coronary Artery Bypass Grafting After Percutaneous Intervention Has Higher Early Mortality: A Meta-Analysis

Ann Thorac Surg. 2015 Jun;99(6):2046-52. doi: 10.1016/j.athoracsur.2014.12.073. Epub 2015 Apr 9.


Background: We compared early adverse events and midterm survival between primary coronary artery bypass grafting (pCABG) and CABG in patients with percutaneous intervention (secondary CABG, sCABG) because data on this topic are very limited.

Methods: A systematic review of published literature was done to obtain original studies fulfilling the search criteria. The end points studied were early mortality, stroke, renal failure, myocardial infarction, and the need for an intra-aortic balloon pump. A random-effect inverse variance weighted analysis was performed. The results are presented as risk ratios (RR) (95% confidence interval); p < 0.05 was considered statistically significant.

Results: Fourteen studies (84,983 pCABG patients and 14,775 sCABG patients) were included in the systematic review. Early mortality was lower with primary CABG (RR 1.54 [1.19-2]; p = 0.007). The incidence of myocardial infarction was also less with pCABG than with sCABG. (RR 1.46 [1.04-2.06]; p = 0.06). Patients undergoing pCABG were 14% (0% to 55%; p = 0.04). Less likely to need an intra-aortic balloon pump. Although renal failure was lower with pCABG (RR 1.254 [1.047-1.502]; p = 0.014), the stroke rates were comparable in both cohorts (p = 0.95). Renal failure was favorable in the primary CABG cohort. Early stroke was comparable between the two cohorts (p = 0.95). The pooled hazard ratios demonstrated comparable survival at the end of 3 years (p = 0.36).

Conclusions: Patients undergoing CABG after prior percutaneous therapy have a higher incidence of myocardial infarction and mortality in the postoperative period. However, midterm survival is comparable in both cohorts.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Coronary Artery Bypass / methods*
  • Coronary Artery Bypass / mortality*
  • Coronary Artery Disease / mortality
  • Coronary Artery Disease / surgery
  • Global Health
  • Humans
  • Percutaneous Coronary Intervention / adverse effects*
  • Reoperation / mortality
  • Risk Factors
  • Survival Rate / trends
  • Treatment Failure