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Incidence of atrial fibrillation after off-pump versus on-pump coronary artery bypass grafting: A meta-analysis of
Chuang-Yan Wu1, Si-Hua Wang2, Yu-Qiang Shang3
1Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Insights
Off-pump coronary artery bypass grafting (OPCABG) may reduce the incidence of atrial fibrillation (AF) after surgery compared to conventional CABG (cCABG). Younger patients appear to benefit more from OPCABG, experiencing lower rates of post-CABG AF.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Atrial Fibrillation Research
Background:
- Atrial fibrillation (AF) is a common complication following coronary artery bypass grafting (CABG).
- The association between surgical techniques, specifically on-pump (conventional CABG, cCABG) versus off-pump CABG (OPCABG), and post-CABG AF remains debated.
- Previous studies have reported inconsistent findings regarding the preferred surgical approach to minimize AF incidence.
Purpose of the Study:
- To conduct a comprehensive meta-analysis evaluating the association between OPCABG and cCABG and the incidence of post-CABG AF.
- To compare outcomes from randomized clinical trials (RCTs) and propensity score matching (PSM) studies.
- To investigate potential age-related differences in AF incidence between the two surgical techniques.
Main Methods:
- Systematic literature search of PubMed, Embase, Web of Science, and Cochrane databases.
- Inclusion of 35 studies (36 independent reports) comprising RCTs and PSM trials.
- Meta-analysis using fixed-effect, random-effect, and quality-effect modeling to determine the overall odds ratio (OR) for post-CABG AF.
Main Results:
- The overall meta-analysis indicated a reduced incidence of post-CABG AF with OPCABG compared to cCABG (OR = 0.80; 95% CI 0.71-0.91).
- Analysis of RCTs showed a stronger protective effect of OPCABG (OR = 0.69; 95% CI 0.56-0.86).
- Studies involving younger patients (≤65 years) demonstrated a significantly lower incidence of AF with OPCABG (OR = 0.76; 95% CI 0.64-0.90), while results for older patients were not statistically significant (OR = 0.90; 95% CI 0.78-1.05).
Conclusions:
- OPCAB surgery is associated with a lower incidence of post-CABG AF compared to cCABG.
- Younger patient populations may experience greater benefits from OPCABG, with a more pronounced reduction in AF incidence.
- The findings support OPCABG as a potentially favorable surgical strategy for reducing AF complications, particularly in younger individuals undergoing CABG.
Abstract:
The association between atrial fibrillation (AF) after coronary artery bypass grafting (CABG) and the surgical techniques selected has been extensively reported. However, no consistent results were obtained. In the present study, a meta-analysis was conducted by searching the electronic databases PubMed, Embase, Web of Science, and Cochrane to identify the association of post-CABG AF with on-pump (conventional CABG, cCABG) or off-pump CABG (OPCABG). Outcomes from randomized clinical trials (RCTs) and propensity score matching (PSM) trials were pooled by using the fixed-effect or the random-effect modeling method, and verified by the quality-effect modeling method. There were 35 studies with 36 independent reports that met the inclusion criteria and were eventually included in our meta-analysis. The total odds ratio (OR) of the incidence of post-CABG AF between OPCABG and cCABG was 0.80 (95% CI 0.71-0.91). The 25 randomized clinical trials (RCTs) had an OR of 0.69 (95% CI 0.56-0.86), while the OR of the 11 PSM trials was 0.88 (95% CI 0.77-1.00). Twenty-six studies involving the patients at a mean age no more than 65 years showed an OR of 0.76 (95% CI 0.64-0.90), whereas 10 studies with patients greater than 65 years old showed an OR of 0.90 (95% CI 0.78-1.05). The results of this meta-analysis suggest that OPCAB surgery may reduce the incidence of post-CABG AF when compared to cCABG and that younger patients may benefit more from OPCAB and have a lower incidence of post-CABG AF.
