Coronary artery bypass grafting history and acute coronary syndromes, meta-analysis

Abstract

Background: A recent global rise in the number of acute coronary syndromes (ACS) has been observed in patients with prior coronary artery bypass (CABG). Moreover there has been a recent debate regarding its short and long-term prognostic influence. Purpose: Elaborate a meta-analysis to study the prognostic influence of a previous CABG in patients admitted for an ACS. Methods: A system review was performed through January 2013 (MEDLINE, Cochrane Library, Web of Knowledge). All published observational studies in which ACS outcomes with a previous history of CABG were compared with ACS outcomes with no history of previous CABG, were considered for inclusion. Reviews meeting the inclusion criteria underwent data extraction by one reviewer and were checked by a second. The endpoints of interest were mortality and non-fatal acute myocardial infarction. Data were aggregated at 3 follow-up times (in-hospital, 30 days, 1 year) using random-effects models. Results: Twenty-five studies were included; 19 provided sufficient data for inclusion with 366639 patients available for analysis. During hospital stay, mortality was 16.2% for the previous CABG group vs 12.3% for the rest of the ACS population (risk ratio [RR] = 1.26, 95% confidence interval [CI] 1.09 – 1.46). Pooled thirty day mortality was also significantly higher for the previous CABG patients as was the one-year mortality (RR=1.77, 95% CI 1.45 – 2.17). The in-hospital re-infarction rate was 4.7% for the previous CABG patients, versus 3.3% for the rest of the ACS population (RR = 1.28, 95% CI 0.90 – 1.83). On the contrary, one-year re-infarction was higher for the previous CABG group (RR 1.73, 95% CI 1.29 – 2.31). ![Figure][1] In hospital mortality Conclusions: ACS patients with previous CABG history have a higher risk for short and long-term events. [1]: pending:yes