Native Coronary Artery Versus Saphenous Vein Graft Percutaneous Coronary Intervention in Patients with Prior Coronary Artery Bypass Grafting: An Updated Systematic Review and Meta-Analysis
- 1Department of Internal Medicine, University of Connecticut Health, Farmington, CT 06030, USA
- 2Department of Cardiology, Hartford Hospital, Hartford, CT 06106, USA
- 3Division of Cardiology, University of Connecticut Health, Farmington, CT 06030, USA
Abstract
Background/Objectives: Patients with prior coronary artery bypass grafting (CABG) frequently require repeat percutaneous coronary intervention (PCI), but the optimal target—native coronary artery or saphenous vein graft (SVG)—remains uncertain. We performed an updated systematic review and random-effects meta-analysis comparing clinical and procedural outcomes of native coronary artery PCI versus SVG PCI. Methods: PubMed, Embase, and the Cochrane Library (Cochrane Central Register of Controlled Trials) were searched from inception through May 2026. Results: Twenty-five studies (343,524 patients) were included, with 21 contributing to the MACE and/or all-cause mortality analyses. Compared with native-vessel PCI, SVG PCI was associated with higher rates of major adverse cardiovascular events (MACE) (risk ratio [RR] 1.30, 95% confidence interval [CI] 1.05–1.60; p = 0.017), all-cause mortality (RR 1.47, 95% CI 1.19–1.81; p < 0.001), myocardial infarction (RR 1.64, 95% CI 1.31–2.05; p < 0.001), in-stent restenosis (RR 1.71, 95% CI 1.19–2.44; p = 0.004), and target lesion revascularization (RR 1.70, 95% CI 1.16–2.47; p = 0.006). After exclusion of the single randomized trial, associations for MACE (RR 1.38, 95% CI 1.12–1.71) and all-cause mortality (RR 1.50, 95% CI 1.21–1.85) were slightly stronger. Cardiac death, stroke, and bleeding did not differ significantly. Findings for MACE and target lesion revascularization were sensitive to the omission of single studies. In the exploratory drug-eluting stent-predominant subgroup, effect directions were generally consistent. Despite these associations, most included studies were observational, and substantial heterogeneity and residual confounding remain important limitations (95% prediction intervals for MACE and mortality included the null), and the certainty of evidence (GRADE) was low to very low. Conclusions: SVG PCI was associated with less favorable long-term outcomes than native coronary artery PCI, although these findings do not establish causality and should be interpreted alongside randomized evidence supporting individualized, anatomy-based target selection. Adequately powered randomized trials with extended follow-up are needed to define the optimal revascularization strategy across the spectrum of post-CABG anatomy.
Related
- The impact of the SYNTAX score on the incidence of in-hospital cardiac arrest in patients with acute coronary syndrome undergoing percutaneous coronary intervention: a retrospective cohort study
- Association Between Admission Calculated Serum Osmolality and New-Onset Atrial Fibrillation in Patients with Non-ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention
- Guided P2Y12 inhibitor selection after rapid CYP2C19 genotyping in patients undergoing percutaneous coronary intervention
- Antiplatelet Therapy Strategies in Patients with High Bleeding Risk Treated with Complex Percutaneous Coronary Intervention: A Descriptive Study
- Aspirin vs. Clopidogrel Monotherapy Beyond 1 Month After Percutaneous Coronary Intervention in Patients With Diabetes ― Prespecified Subgroup Analysis of the STOPDAPT-3 Trial ―
BibTeX
@article{patel2026native,
title = {{Native Coronary Artery Versus Saphenous Vein Graft Percutaneous Coronary Intervention in Patients with Prior Coronary Artery Bypass Grafting: An Updated Systematic Review and Meta-Analysis}},
author = {Vaishvik Patel and Ahmed Al-Ghazawy and Jay Patel and Oluwakorede Akele and Ryan Englander and Abhishek Singh and Joseph Ingrassia and Khagendra Dahal},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218672},
url = {https://www.mdpi.com/2077-0383/15/21/8672},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Native Coronary Artery Versus Saphenous Vein Graft Percutaneous Coronary Intervention in Patients with Prior Coronary Artery Bypass Grafting: An Updated Systematic Review and Meta-Analysis
AU - Vaishvik Patel
AU - Ahmed Al-Ghazawy
AU - Jay Patel
AU - Oluwakorede Akele
AU - Ryan Englander
AU - Abhishek Singh
AU - Joseph Ingrassia
AU - Khagendra Dahal
PY - 2026
DA - 2026/11/06
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218672
UR - https://www.mdpi.com/2077-0383/15/21/8672
AB - Background/Objectives: Patients with prior coronary artery bypass grafting (CABG) frequently require repeat percutaneous coronary intervention (PCI), but the optimal target—native coronary artery or saphenous vein graft (SVG)—remains uncertain. We performed an updated systematic review and random-effects meta-analysis comparing clinical and procedural outcomes of native coronary artery PCI versus SVG PCI. Methods: PubMed, Embase, and the Cochrane Library (Cochrane Central Register of Controlled Trials) were searched from inception through May 2026. Results: Twenty-five studies (343,524 patients) were included, with 21 contributing to the MACE and/or all-cause mortality analyses. Compared with native-vessel PCI, SVG PCI was associated with higher rates of major adverse cardiovascular events (MACE) (risk ratio [RR] 1.30, 95% confidence interval [CI] 1.05–1.60; p = 0.017), all-cause mortality (RR 1.47, 95% CI 1.19–1.81; p < 0.001), myocardial infarction (RR 1.64, 95% CI 1.31–2.05; p < 0.001), in-stent restenosis (RR 1.71, 95% CI 1.19–2.44; p = 0.004), and target lesion revascularization (RR 1.70, 95% CI 1.16–2.47; p = 0.006). After exclusion of the single randomized trial, associations for MACE (RR 1.38, 95% CI 1.12–1.71) and all-cause mortality (RR 1.50, 95% CI 1.21–1.85) were slightly stronger. Cardiac death, stroke, and bleeding did not differ significantly. Findings for MACE and target lesion revascularization were sensitive to the omission of single studies. In the exploratory drug-eluting stent-predominant subgroup, effect directions were generally consistent. Despite these associations, most included studies were observational, and substantial heterogeneity and residual confounding remain important limitations (95% prediction intervals for MACE and mortality included the null), and the certainty of evidence (GRADE) was low to very low. Conclusions: SVG PCI was associated with less favorable long-term outcomes than native coronary artery PCI, although these findings do not establish causality and should be interpreted alongside randomized evidence supporting individualized, anatomy-based target selection. Adequately powered randomized trials with extended follow-up are needed to define the optimal revascularization strategy across the spectrum of post-CABG anatomy.
SN - 2077-0383
ER -