LAUSR

There is conflicting evidence for adverse outcomes after coronary artery bypass surgery (CABG) with prior percutaneous intervention (PCI). A literature search was performed for 1998-2017 and articles with primary or secondary outcomes of survival, major adverse cardiovascular events, myocardial infarction in CABG patients with prior PCI were included. Forest plots were generated from odds ratios for survival, major adverse cardiovascular events and myocardial infarction for unmatched and propensity matched data. Heterogeneity between studies was assessed for all outcomes using I2. Funnel plots were generated for early survival, survival at 5 years, survival at >5 years and MACE. Thirty-one studies were included over 18 years with 194,544 patients without PCI prior to CABG and 23,519 patients (12.09%) with prior PCI. Prior PCI did not adversely affect survival among the included studies (IRR: 1.12, 95% CI: 0.98-1.27, p=0.110. MACE was significantly worse for those with prior PCI (OR; 1.26, CI; 1.02-1.55, p=0.03). The relative risk of mortality associated with prior PCI has decreased significantly over the last two decades. Studies with higher percentage of prior PCI patients had higher relative mortalities. There was significant heterogeneity between studies for the treatment effects. PCI prior to CABG in recent times does not adversely affect survival despite adverse early and late MACE rates. However, high institutional rates of prior PCI may be associated with increasing mortality after CABG.