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A meta‐analysis of ≥5‐year mortality in randomized controlled trials of off‐pump versus on‐pump coronary artery bypass grafting
Author(s) -
Takagi Hisato,
Hari Yosuke,
Mitta Shohei,
Kawai Norikazu,
Ando Tomo
Publication year - 2018
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.13828
Subject(s) - medicine , meta analysis , relative risk , hazard ratio , randomized controlled trial , off pump coronary artery bypass , cardiology , odds ratio , artery , confidence interval , bypass grafting , surgery
Objectives We sought to determine whether off‐pump coronary artery bypass grafting (CABG) increases long‐term mortality, by performing a meta‐analysis of randomized controlled trials (RCTs) of off‐pump versus on‐pump CABG with ≥5‐year follow‐up. Methods MEDLINE and EMBASE, and the Cochrane Central Register of Controlled Trials were searched through July 2018. Hazard, risk, or odds ratios (HRs, RRs, or ORs) of long‐term (≥5‐year) mortality for off‐pump versus on‐pump CABG were extracted from each individual trial. Study‐specific estimates were combined using inverse variance‐weighted averages of logarithmic HRs in the random‐effects model. Results Our search identified eight medium‐ to large‐size RCTs at low risk of bias with long‐term follow‐up of off‐pump versus on‐pump CABG enrolling a total of 8780 patients. Combining four RCTs reporting actual HRs generated a statistically significant result favoring on‐pump CABG (HR, 1.21; P = 0.02). A pooled analysis of all eight RCTs demonstrated a statistically significant increase in mortality with off‐pump CABG (HR/RR, 1.19; P = 0.01). There was no evidence of significant publication bias in the meta‐analysis of all eight RCTs. In a sensitivity analysis, extracting RRs or ORs from all eight RCTs and pooling them demonstrated a statistically significant increase in mortality with off‐pump CABG (RR, 1.17; P = 0.01; OR, 1.20; P = 0.007). Eliminating 2 RRs and combining six HRs still generated a statistically significant result favoring on‐pump CABG (HR, 1.19; P = 0.05). Conclusions Off‐pump CABG increases long‐term (≥5‐year) mortality compared with on‐pump CABG.