Meta-Analysis of Repeat Revascularization of Off-Pump and On-Pump Coronary Artery Bypass Surgery

Abstract

Background: There is an ongoing debate focusing on clinical outcomes after off-pump coronary artery bypass graft surgery (OPCABG) and on-pump coronary artery bypass graft surgery (ONCABG). The objective of the present meta-analysis is to update and compare repeat revascularization rates between OPCABG and ONCABG procedures.

Methods: Data sources including PubMed, EMBASE, Cochrane Library, and ISI Web of Knowledge were searched between 1966 and October 2017. Studies considered for inclusion should conform to the following criteria: prospective randomized clinical trials comparing OPCABG and ONCABG. Outcome should include repeat revascularization rate at the time of 1-month, 1-year, or 5-year follow-up.

Results: A literature search yielded 11 randomized controlled trials, and a total of 11,246 patients were randomly allocated to OPCABG or ONCABG procedures. Pooled analysis demonstrated a statistically significant 53% increase in repeat revascularization rate at 1-year follow-up with OPCABG relative to ONCABG in the fixed effects model (odds ratio 1.53, 95% confidence interval: 1.17 to 2.00, p = 0.002), whereas there was no significant difference in repeat revascularization rate at 5-year follow-up between OPCABG and ONCABG in the fixed effects model (OR 1.16, 95% confidence interval: 0.95 to 1.41, p = 0.14). In general, exclusion of any single trial did not affect repeat revascularization rate at 1-year and 5-year follow-up. There was no evidence of significant publication bias.

Conclusions: The result of our meta-analysis suggests that compared with ONCABG, OPCABG increases repeat revascularization rate at 1-year follow-up, but does not affect that of 5-year follow-up.