Off-pump coronary artery bypass grafting improves short-term outcomes in high-risk patients compared with on-pump coronary artery bypass grafting: Meta-analysis

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 151; no. 1; pp. 60 - 77.e58
• Main Authors: Kowalewski, Mariusz, Pawliszak, Wojciech, Malvindi, Pietro Giorgio, Bokszanski, Marek Pawel, Perlinski, Damian, Raffa, Giuseppe Maria, Kowalkowska, Magdalena Ewa, Zaborowska, Katarzyna, Navarese, Eliano Pio, Kolodziejczak, Michalina, Kowalewski, Janusz, Tarelli, Giuseppe, Taggart, David Paul, Anisimowicz, Lech
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2016
• Subjects: Aged; Aged, 80 and over; cardiopulmonary bypass; Cardiopulmonary Bypass - adverse effects; Cardiopulmonary Bypass - mortality; Cardiothoracic Surgery; cerebrovascular disorders; Chi-Square Distribution; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - methods; Coronary Artery Bypass - mortality; Coronary Artery Bypass, Off-Pump - adverse effects; Coronary Artery Bypass, Off-Pump - mortality; Coronary Artery Disease - diagnosis; Coronary Artery Disease - mortality; Coronary Artery Disease - surgery; coronary disease; Female; Hospital Mortality; Humans; Linear Models; Male; Middle Aged; Myocardial Infarction - etiology; Myocardial Infarction - mortality; Odds Ratio; Patient Selection; Protective Factors; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Stroke - etiology; Stroke - mortality; Time Factors; Treatment Outcome; ROOBY; 23; 45; RCT; OR; 25; ECC; CORONARY; CI; 28; CAD; PRISMA; coronary disease; NNT; PCI; cardiopulmonary bypass; EuroSCORE; cerebrovascular disorders; CABG; MI; OPCAB; Myocardial infarction; European System for Cardiac Operative Risk Evaluation; Percutaneous coronary intervention; Preferred Reporting Items for Systematic Reviews and Meta-Analyses; Extracorporeal circulation; Number needed to treat; Coronary artery bypass grafting; Veterans Affairs Randomized On/Off Bypass Trial; Coronary artery disease; Randomized controlled trial; Confidence interval; CABG Off or On Pump Revascularization Study; Odds ratio; Off-pump coronary artery bypass
• ISSN: 0022-5223; 1097-685X; 1097-685X
• DOI: 10.1016/j.jtcvs.2015.08.042

To assess the benefits and risks of off-pump coronary artery bypass (OPCAB) versus coronary artery bypass grafting (CABG) through a meta-analysis of randomized controlled trials (RCTs), and to investigate the relationship between outcomes and patient risk profile. PubMed, Embase, the Cumulative Index of Nursing and Allied Health Literature, Scopus, Web of Science, Cochrane Library, and major conference proceedings databases were searched for RCTs comparing OPCAB and CABG and reporting short-term (≤30 days) outcomes. Endpoints assessed were all-cause mortality, myocardial infarction (MI), and cerebral stroke. The meta-analysis included 100 studies, with a total of 19,192 subjects. There was no difference between the 2 techniques with respect to all-cause mortality and MI (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.71-1.09; P = .25; I2 = 0% and OR, 0.90; 95% CI, 0.77-1.05; P = .19; I2 = 0%, respectively). OPCAB was associated with a significant 28% reduction in the odds of cerebral stroke (OR, 0.72; 95% CI, 0.56-0.92; P = .009; I2 = 0%). A significant relationship between patient risk profile and benefits from OPCAB was found in terms of all-cause mortality (P < .01), MI (P < .01), and cerebral stroke (P < .01). OPCAB is associated with a significant reduction in the odds of cerebral stroke compared with conventional CABG. In addition, benefits of OPCAB in terms of death, MI, and cerebral stroke are significantly related to patient risk profile, suggesting that OPCAB should be strongly considered in high-risk patients.