Impact of risk factors and surgical techniques in coronary endarterectomy: a network meta-analysis

The goal of this network meta-analysis was to compare the early mortality rate of patients who underwent coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) with different techniques and with isolated CABG. This analysis also evaluated potential risk factors in patients who undergo CE. Eighteen studies were included, covering 21 752 different patients, among whom 3352 underwent CE + CABG with either open or closed techniques and 18 400 underwent isolated CABG. Patients who had CE + CABG had a statistically significant higher mortality rate [odds ratio (OR) 1.76; P < 0.001]. Subgroup analyses showed that, with closed CE, mortality was 52% (OR 1.52, P = 0.001) more likely to occur, whereas with open CE, mortality was 279% (OR 3.79, P < 0.001) more likely to occur, when both were compared with isolated CABG. A network meta-analysis indicated that both the open and closed methods had poorer results than CABG alone and that the open method had a higher risk of mortality than the closed one. For risk factors, diabetes mellitus (DM), hypertension, prior myocardial infarction, peripheral vascular disease and renal failure were significant contributors to inclusion in the CE group, whereas other risk factors showed no significant difference. However, none of these factors indicated significant correlations with the incidence of mortality between the groups. CE + CABG has a significantly higher risk of death than isolated CABG, and open CE is more risky than closed CE, even though most of the individual studies did not show that CE had a higher risk of mortality. Moreover, DM, hypertension, prior myocardial infarction, peripheral vascular disease and renal failure were more common in the patients who had CE + CABG, but these factors may not necessarily increase the mortality risk of patients who have CE.