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

Objective: This review assessed evidence on the impact of prior coronary artery bypass grafting (CABG) on outcomes of percutaneous coronary intervention (PCI) for chronic total occlusions (CTO). Methods: PubMed, CENTRAL, Embase, ScienceDirect, and Google Scholar databases were searched from 1st January 1980 up to 10th January 2022 for studies assessing outcomes of CTO-PCI in patients with and without prior-CABG. Results: Eight studies were included. The meta-analysis demonstrated significantly reduced odds of procedural success in patients with prior history of CABG (OR: 0.51 95% CI: 0.41, 0.64 I2=84% p<0.00001). There was a tendency of increased in-hospital mortality (OR: 1.72 95% CI: 0.97, 3.04 I2=26% p=0.06) and major adverse cardiac events (MACE) (OR: 1.30 95% CI: 0.99, 1.69 I2=0% p=0.05), along with a significantly increased risk of myocardial infarction (MI) (OR: 2.56 95% CI: 1.65, 3.97 I2=0% p<0.0001) and coronary perforation (OR: 1.52 95% CI: 1.03, 2.24 I2=70% p=0.04) in patients with history of CABG. There was no difference in the risk of stroke, pericardial tamponade, major bleeding, vascular access complications, and renal failure. Conclusion: Our results suggest that patients with prior history of CABG undergoing PCI for CTO have a 49% reduced chance of procedural success. Such patients are at an increased risk of in-hospital mortality, MACE, MI, and coronary perforation.