Meta-analysis of on-pump and off-pump coronary arterial revascularization.

Abstract

There is no agreement whether off-pump coronary artery bypass (OPCAB) can reduce mortality, rates of stroke, myocardial infarction, or revascularization when compared with conventional coronary artery bypass (CCAB). We performed a meta-analysis comparing off-pump coronary artery bypass with conventional coronary artery bypass in randomized controlled trials. We comprehensively retrieved randomized controlled studies according to predetermined criteria. We performed meta-analyses for each outcome and empirically determined whether potential biases that might result from differences in study design or patient characteristics actually biased the results of a study. We also conducted sensitivity analyses and tested for publication bias. We undertook a meta-analysis of ten randomized trials (2,018 patients) of OPCAB surgery versus CCAB surgery. No significant differences were found for 1-year mortality (odds ratio [OR], 1.00; 95% confidence interval [CI], 0.56 to 1.77), [corrected] myocardial infarction (OR, 1.38; 95% CI, 0.72 to 2.67), [corrected] stroke (OR, 0.56; 95% CI, 0.21 to 1.47), or revascularization (OR, 1.38; 95% CI, 1.00 to 1.92). Therefore, this meta-analysis demonstrates that mortality, stroke, myocardial infarction, and revascularization were not reduced in OPCAB. In conclusion, OPCAB did not significantly reduce 1-year mortality, stroke, myocardial infarction, and revascularization compared with CCAB.