Lesion characteristics and procedural complications of chronic total occlusion percutaneous coronary intervention in patients with prior bypass surgery: A meta‐analysis

Abstract

Coronary artery bypass graft (CABG) accelerates the prevalence of native coronary chronic total occlusion (CTO), and this kind of CTO shows extensive challenging and complex atherosclerotic pathology. As a result, the procedural success rate of percutaneous coronary intervention (PCI) is inferior to another kind of lesions. The present meta-analysis aims to compare the lesion characteristics and procedural complications of CTO-PCI in patients with or without prior CABG. A total of 8 studies, comprising of 13439 patients, published from inception to August 2021 were included in this meta-analysis. Results were pooled using random effects model and are presented as odds ratio (OR) with 95% confidence intervals (95% CIs). From the 13439 patients enrolled, 3349 (24.9%) patients had previous CABG and 10090 (75.1%) formed the control group in our analysis. For the clinical characteristic, compared to the non-CABG patients, prior CABG patients were older (OR, 3.98; 95% CI,

Comparison of outcomes of percutaneous coronary intervention for chronic total occlusion in patients with and without prior bypass grafting: A systematic review and meta-analysis

“…We noted that in patients with prior CABG the odds of procedural success are significantly reduced. Our results are similar to the prior meta-analysis of Liu et al 16 However, the more recent review of Shi et al 15 did not analyze success rates. Lower procedural success with prior CABG could be attributable to several reasons.…”

“…Secondly, there was increased risk of MI and coronary perforation in patients with a history of CABG, but no difference in other complications. These results are similar to Liu et al 16 However, Shi et al 15 in their meta-analysis have also noted the reduced incidence of cardiac tamponade and higher rates of contrast-induced nephropathy in patients with prior CABG.…”

“…It is pertinent to mention that the studies included in our review and that of Shi et al 15 are not the same. Two of the studies 21 , 22 included by Shi et al 15 had overlapping data with Azzalini et al 27 and to evaluate the role of the Registry of CrossBoss and Hybrid procedures in France, the Netherlands, Belgium, and United Kingdom (RECHARGE and Nikolakopoulos et al 13 and hence were excluded from our meta-analysis. Including the same patients twice in a pooled analysis can exaggerate the effect of the intervention thereby generating false results.…”

“…Two meta-analysis studies have been conducted on this topic. 15 , 16 While one review 16 could only include studies published up to 2019, another recent review 15 included studies with overlapping data reporting outcomes from the same institute or PCI registries thereby resulting in biased reporting. Furthermore, more recently published studies 14 , 17 were not included in both these reviews.…”

Procedural Characteristics and Clinical Outcomes Associated with Chronic Total Occlusion Percutaneous Coronary Intervention in Patients with a History of Prior Coronary Artery Bypass Graft: A Meta-Analysis

“…Moreover, a history of prior CABG is associated with negative vascular remodeling and more rapid atherosclerotic disease progression following this procedure, resulting in further increases in procedural complexity. In a prior meta-analysis, we found CABG patients undergoing CTO-PCI to exhibit more complex lesion characteristics including higher J-CTO scores, longer lesion length, greater levels of calcification, and more proximal cap ambiguity [ 15 ]. These results are shown in Supplementary Fig.…”