Off-pump versus on-pump coronary artery bypass surgery: meta-analysis and meta-regression of 13,524 patients from randomized trials

Revista Brasileira de Cirurgia Cardiovascular

Michel Pompeu Barros De Oliveira Sá¹  Paulo Ernando Ferraz¹  Rodrigo Renda Escobar¹  Wendell Nunes Martins¹  Pablo César Lustosa¹  Eliobas De Oliveira Nunes¹  Frederico Pires Vasconcelos¹  Ricardo Carvalho Lima¹ 

[1] ,Pronto Socorro Cardiológico de Pernambuco Division of Cardiovascular Surgery

关键词: Meta-Analysis;    Coronary artery bypass;    off-pump;    Cardiopulmonary bypass;    Metanálise;    Ponte de artéria coronária sem circulação extracorpórea;    Ponte cardiopulmonar;   

DOI  :  10.5935/1678-9741.20120106

来源: SciELO

【 摘 要 】

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.

【 授权许可】

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