Worse long-term survival after off-pump than on-pump coronary artery bypass grafting

ObjectiveTo determine whether off-pump coronary artery bypass grafting (CABG) is associated with worse long-term survival compared with on-pump CABG. We performed a meta-analysis of adjusted observational studies and randomized controlled trials.MethodsMEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through March 2014. Eligible studies were randomized controlled trials and adjusted observational studies (in which appropriate statistical methods adjusting for confounders had been used) of off-pump versus on-pump CABG that had reported long-term (≥5-year) all-cause mortality as an outcome.ResultsOf 478 potentially relevant studies screened initially, 5 randomized trials and 17 observational studies, enrolling a total of 104,306 patients, were identified and included. A pooled analysis of all 22 studies demonstrated a statistically significant 7% increase in long-term all-cause mortality with off-pump relative to on-pump CABG (hazard ratio, 1.07; 95% confidence interval, 1.03-1.11; P = .0003). Although a pooled analysis of 5 randomized trials (1486 patients) demonstrated a statistically nonsignificant 14% increase in mortality with off-pump relative to on-pump CABG (hazard ratio, 1.14; 95% confidence interval, 0.84-1.56; P = .39), another pooled analysis of 17 observational studies (102,820 patients) demonstrated a statistically significant 7% increase in mortality with off-pump relative to on-pump CABG (hazard ratio, 1.07; 95% confidence interval, 1.03-1.11; P = .0004).ConclusionsA meta-analysis of 22 studies, enrolling a total of >100,000 patients, showed that off-pump CABG is likely associated with worse long-term (≥5-year) survival compared with on-pump CABG.