Meta-analysis Of Randomized Controlled Trials Comparing Off-pump With On-pump Coronary Artery Bypass Grafting

Objective To assess differences in clinical outcomes between off pump coronary artery bypass (OPCAB) and conventional coronary artery bypass grafting (CCABG) by meta-analysis of data published in randomized controlled trials(RCTs).Methods Relevant RCTs, published in English and Chinese before March 2009, were searched in Medline, the Science Citation Index Expanded, the Cochrane Central Register of Controlled Trials (CENTRAL) and Chinese Biomedical Literature Database (CBM). Manual searches of bibliographies were also performed. Two reviewers independently selected eligible trials, performed quality assessment and abstracted relevant data. The meta-analysis was performed using RevMan 5.Results 34 RCTs were selected for meta analysis after screening a total of 2156 studies. Graft patency was reported in seven studies,with 641 patients in the OPCAB group and 632 in the CCABG group. Meta-analysis of these trials showed a significant increase of graft occlusion in the OPCAB group, both after three months follow-up (odds ratio(OR)=1.84, 95% confidence interval(CI)= 1.15-2.95,P=0.01) and one year follow-up (OR=1.34, 95%CI=1.01-1.78,P=0.04). 22 trials reporting occurrence of atrial fibrillation (AF) met our selection criteria. The incidence of AF was 19% (311/1653) in the OPCAB group and 28% (458/1637) in the CCABG group. OPCAB was associated with significantly reduced AF (OR=0.62, 95%CI =0.47-0.83,P=0.001). Myocardial infarction (MI) was assessed in 22 trials. The incidence of MI was 2.81% (42/1494) in the OPCAB group and 3.57% (54/1512) in the CCABG group. No significant difference was found between two groups (OR=0.80, 95%CI=0.54-1.20, P=0.28).Conclusions Our meta analysis of current available RCTs suggests that, compared with CCABG, OPCAB is associated with lower incidence of AF, similar incidence of MI, but lower graft patency.