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Published on: September 15, 2023
Off-pump versus on-pump coronary artery bypass surgery: meta-analysis and meta-regression of 13,524 patients from
Michel Pompeu Barros de Oliveira Sá1, Paulo Ernando Ferraz, Rodrigo Renda Escobar
1Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco, Recife, PE, Brazil. michel_pompeu@yahoo.com.br
Insights
Off-pump coronary artery bypass graft surgery (CABG) significantly reduces stroke incidence by 20.7% compared to on-pump CABG. This meta-analysis found no significant differences in mortality or myocardial infarction rates between the two surgical approaches.
Area of Science:
- Cardiovascular Surgery
- Evidence-Based Medicine
- Meta-Analysis
Background:
- Previous meta-analyses indicated off-pump coronary artery bypass graft surgery (CABG) reduces stroke risk by 30% versus on-pump CABG.
- No significant differences in other outcomes were noted in prior meta-analyses.
- Recent randomized controlled trials (RCTs) necessitate an updated meta-analysis to incorporate new data.
Purpose of the Study:
- To conduct a new meta-analysis of RCTs comparing off-pump versus on-pump CABG.
- To investigate pooled results for 30-day mortality, myocardial infarction, and stroke incidence.
- To update the evidence on the comparative effectiveness of off-pump CABG.
Main Methods:
- Searched MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar, and reference lists for RCTs until May 2012.
- Included 47 RCTs with 13,524 patients comparing off-pump and on-pump CABG.
- Utilized DerSimonian-Laird random effects model for meta-analysis and meta-regression.
Main Results:
- No significant difference in 30-day mortality or myocardial infarction between off-pump and on-pump CABG.
- Off-pump CABG showed a statistically significant reduction in stroke incidence (RR 0.793, P=0.049).
- Meta-regression analysis found no influence of gender, graft number, or age on outcomes; publication bias for stroke was noted.
Conclusions:
- Off-pump CABG is associated with a 20.7% reduction in post-operative stroke incidence compared to on-pump CABG.
- No substantial differences in mortality or myocardial infarction were observed between the two techniques.
- Patient demographics and surgical factors do not appear to explain the observed effects of off-pump CABG on key outcomes.
Background:
Most recent published meta-analysis of randomized controlled trials (RCTs) showed that off-pump coronary artery bypass graft surgery (CABG) reduces incidence of stroke by 30% compared with on-pump CABG, but showed no difference in other outcomes. New RCTs were published, indicating need of new meta-analysis to investigate pooled results adding these further studies.
Methods:
MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles were searched for RCTs that compared outcomes (30-day mortality for all-cause, myocardial infarction or stroke) between off-pump versus on-pump CABG until May 2012. The principal summary measures were relative risk (RR) with 95% Confidence Interval (CI) and P values (considered statistically significant when <0.05). The RR's were combined across studies using DerSimonian-Laird random effects weighted model. Meta-analysis and meta-regression were completed using the software Comprehensive Meta-Analysis version 2 (Biostat Inc., Englewood, New Jersey, USA).
Results:
Forty-seven RCTs were identified and included 13,524 patients (6,758 for off-pump and 6,766 for on-pump CABG). There was no significant difference between off-pump and on-pump CABG groups in RR for 30-day mortality or myocardial infarction, but there was difference about stroke in favor to off-pump CABG (RR 0.793, 95% CI 0.660-0.920, P=0.049). It was observed no important heterogeneity of effects about any outcome, but it was observed publication bias about outcome "stroke". Meta-regression did not demonstrate influence of female gender, number of grafts or age in outcomes.
Conclusion:
Off-pump CABG reduces the incidence of post-operative stroke by 20.7% and has no substantial effect on mortality or myocardial infarction in comparison to on-pump CABG. Patient gender, number of grafts performed and age do not seem to explain the effect of off-pump CABG on mortality, myocardial infarction or stroke, respectively.
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