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A meta-analysis of large randomized trials for mid-term major cardio- and cerebrovascular events following off-pump versus on-pump coronary artery bypass grafting.

ABSTRACT: To determine whether off-pump coronary artery bypass grafting (CABG) increases mid-term major adverse cardiovascular (and cerebrovascular) events MACCE over on-pump CABG, we performed a meta-analysis of exclusive large randomized controlled trials (RCTs). Databases including MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched through October 2013 using Web-based search engines (PubMed and OVID). Eligible studies were RCTs of off-pump vs on-pump CABG enrolling >100 patients in each procedure and reporting MACCE at the time of >1 year follow-up. Mixed-effects meta-regression analyses were performed to determine whether the effects of off-pump CABG on MACCE were modulated by the prespecified factors. Eight RCTs enrolling 10 954 patients were identified and included. A pooled analysis demonstrated no statistically significant difference in off-pump and on-pump CABG (hazard ratio, 1.10; 95% confidence interval, 0.93-1.29; P = 0.27). In general, exclusion of any single study from the analysis did not substantially alter the overall result of our analysis. There was no evidence of significant publication bias. Meta-regression coefficients were not statistically significant for mean age, proportion of men and that of diabetes. In conclusion, off-pump CABG appears not to increase mid-term MACCE over on-pump CABG.

SUBMITTER: Takagi H

PROVIDER: S-EPMC3957288 | biostudies-literature | 2014 Apr

REPOSITORIES: biostudies-literature

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A meta-analysis of large randomized trials for mid-term major cardio- and cerebrovascular events following off-pump versus on-pump coronary artery bypass grafting.

Takagi Hisato H Watanabe Taku T Mizuno Yusuke Y Kawai Norikazu N Umemoto Takuya T

Interactive cardiovascular and thoracic surgery 20131230 4

To determine whether off-pump coronary artery bypass grafting (CABG) increases mid-term major adverse cardiovascular (and cerebrovascular) events MACCE over on-pump CABG, we performed a meta-analysis of exclusive large randomized controlled trials (RCTs). Databases including MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched through October 2013 using Web-based search engines (PubMed and OVID). Eligible studies were RCTs of off-pump vs on-pump CABG enrolling >10 ...[more]

PMID: 24381313

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Project description:BackgroundWe evaluated the mid-term outcomes and angiographic patency of redo coronary artery bypass grafting (CABG).MethodsOf 2,851 patients who underwent isolated CABG at Seoul National University Hospital from 2000 to 2017, 88 underwent redo CABG. Patients' mean age at redo CABG was 66.0±8.0 years. The mean interval between the first-time and redo CABG was 113.0±62.4 months. The mean follow-up duration was 86 months. Early and mid-term clinical outcomes were evaluated. Angiographic patency rates were evaluated early (1-2 days), 1 year, and 5 years after surgery. Comparative analyses between on-pump and off-pump CABG were also performed.ResultsThe culprits for reoperation were previous grafts (65.6%), native coronary vessels (17.8%), and both (16.7%). Off-pump CABG was performed in 75 cases (85.2%), and the mean number of distal anastomoses was 1.8±0.8. The saphenous vein (39.7%) was used most frequently, followed by the right internal thoracic artery (28.4%), right gastroepiploic artery (21.3%), left internal thoracic artery (7.8%), and radial artery (2.8%). Operative mortality was 1.1%. The overall survival, cumulative incidence of cardiac death, and cumulative incidence of major adverse cardiac events were 71.3%,12.0%, and 23.3% at 5 years after surgery, respectively. The overall angiographic patency rates were 95.7%, 90.1%, and 92.2% on early, 1-year, and 5-year angiograms, respectively. The angiographic patency rates of saphenous vein grafts were 93.1%, 85.6%, and 91.3% on early, 1-year, and 5-year angiograms, respectively. No significant differences in clinical outcomes or angiographic patency rates were observed between the on-pump (n=13) versus off-pump (n=75) groups. Multivariable analysis revealed that age (hazard ratio [HR], 1.07; p=0.005) and chronic kidney disease (HR, 3.85; p=0.001) were risk factors for all-cause mortality.ConclusionRedo CABG could mostly be performed using the off-pump technique and did not show increased operative mortality and morbidities.

Dataset Information

A meta-analysis of large randomized trials for mid-term major cardio- and cerebrovascular events following off-pump versus on-pump coronary artery bypass grafting.

Publications

A meta-analysis of large randomized trials for mid-term major cardio- and cerebrovascular events following off-pump versus on-pump coronary artery bypass grafting.

Similar Datasets

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