Zhang Hongliang, Zhao Zhenyan, Yao Jing, Zhao Jie, Hou Tao, Wang Moyang, Xu Yanlu, Wang Bincheng, Niu Guannan, Sui Yonggang, Song Guangyuan, Wu Yongjian
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiology, Cixian People's Hospital, Han Dan City, China.
Ther Adv Chronic Dis. 2022 May 13;13:20406223221078755. doi: 10.1177/20406223221078755. eCollection 2022.
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.
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.
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, = 0.003; = 64%] and major adverse cardiovascular events (MACEs; OR: 1.36, 95% CI: 1.12-1.66, = 0.002, = 79%), but not with late (follow-up durations from 1 to 13 years) mortality (OR: 1.03, 95% CI: 0.95-1.13, = 0.44, = 46%) or MACEs (OR: 1.03, 95% CI: 0.97-1.09, = 0.38, = 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, = 0.003; early MACE, OR: 1.50, = 0.001; late mortality, OR: 1.03, = 0.70).
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.
既往经皮冠状动脉介入治疗（PCI）与冠状动脉旁路移植术（CABG）后预后之间的关联仍不确定。我们旨在通过一项荟萃分析评估上述关联。
检索PubMed、Cochrane图书馆和Embase数据库以查找潜在研究。荟萃分析采用随机效应模型。进行Meta回归以评估研究特征对结果的影响。
纳入了36项随访研究，共308,284例患者，其中40,892例（13.3%）患者有既往PCI史。汇总结果显示，既往PCI与早期（住院期间或1个月内）全因死亡风险较高相关[比值比（OR）：1.26，95%置信区间（CI）：1.11 - 1.44，P = 0.003；I² = 64%]以及主要不良心血管事件（MACE）风险较高相关（OR：1.36，95% CI：1.12 - 1.66，P = 0.002，I² = 79%），但与晚期（随访1至13年）死亡（OR：1.03，95% CI：0.95 - 1.13，P = 0.44，I² = 46%）或MACE（OR：1.03，95% CI：0.97 - 1.09，P = 0.38，I² = 0%）无关。Meta回归显示，患者数量、年龄、性别、糖尿病状态以及既往PCI患者比例等研究特征不影响结果。限于排除急性PCI失败患者的多变量研究的敏感性分析显示了相似结果（早期死亡率，OR：1.25，P = 0.003；早期MACE，OR：1.50，P = 0.001；晚期死亡率，OR：1.03，P = 0.70）。
目前的证据大多来自回顾性观察性研究，表明既往PCI与CABG术后早期临床预后不良相关，但与晚期临床预后无关。
