A Meta-Analysis of Randomized Controlled Studies Comparing Off-Pump versus On-Pump Coronary Artery Bypass Grafting in the Elderly

Abstract

Introduction: To compare short and mid-term outcomes between off-pump CABG (OPCAB) and on-pump CABG (ONCAB) in patients older than 60 throughout a meta-analysis of randomized clinical trials (RCTs). Evidence acquisition: A literature search was conducted using 3 databases. RCTs reporting mortality outcomes of OPCAB versus ONCAB among the elderly were included. Data on myocardial infarction, stroke, re-revascularization, renal failure and composite endpoints after CABG were also collected. Random effect models were used to compute statistical combined measures and 95% confidence intervals (CI). Evidence synthesis: Seven RCTs encompassing 6,609 patients were included (3,303 OPCAB and 3,306 ONCAB). There were no significant differences on mid-term mortality (pooled HR: 1.02, 95%CI: 0.88-1.17, p=0.82) and composite endpoint incidence (pooled HR: 0.98, 95%CI: 0.88-1.09, p=0.73) between OPCAB and ONCAB. At 30-days, there were no differences in mortality, myocardial infarction and renal complications. The need for early re-revascularization was significantly higher in OPCAB (pooled OR: 2.58, 95%CI: 1.16-5.75, p=0.02), with higher percentage of incomplete revascularization being reported for OPCAB in trials included in this pooled result (34% in OPCAB vs 29% in ONCAB, p<0.01). However, OPCAB showed a tendency for lower risk of early stroke (pooled OR: 0.70, 95%CI: 0.48-1.03, p=0.07). Conclusions: Data from RCTs in elderly patients showed that OPCAB and ONCAB provide similar mid-term results. OPCAB was associated with a higher risk of early re-revascularization and there was a trend for reduced early stroke risk. Further RCTs, specifically designed for elderly patients, are needed to establish their better CABG strategy.