Key result
Off-pump CABG provided similar mid-term mortality compared to on-pump CABG in elderly patients (HR 1.02; 95% CI 0.89-1.17; P=0.80), but was associated with a higher risk of early re-revascularization.
Why the study?
The short and mid-term outcomes comparing off-pump CABG with on-pump CABG in patients older than 65 required evaluation through randomized clinical trials.
Does off-pump coronary artery bypass grafting improve outcomes compared to on-pump coronary artery bypass grafting in patients older than 65?
Meta-Analysis (n=6,221)
Does off-pump coronary artery bypass grafting improve outcomes compared to on-pump coronary artery bypass grafting in patients older than 65?
Hazard Ratio: 1.02 (95% CI 0.89–1.17)
p-value: p=0.80
In elderly patients undergoing CABG, off-pump and on-pump techniques provide similar mid-term mortality, but off-pump CABG is associated with higher rates of incomplete revascularization and early re-revascularization.
INTRODUCTION: Comparison of short and mid-term outcomes between off-pump CABG (OPCAB) and on-pump CABG (ONCAB) in patients older than 65 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 effects models were used to compute statistical combined measures and 95% confidence intervals (CI). EVIDENCE SYNTHESIS: Five RCTs encompassing 6221 patients were included (3105 OPCAB and 3116 ONCAB). There were no significant differences on mid-term mortality (pooled HR: 1.02, 95%CI: 0.89-1.17, P=0.80) and composite endpoint incidence (pooled HR: 0.98, 95%CI: 0.88-1.09, P=0.72) between OPCAB and ONCAB. At 30-day, there were no differences in mortality, myocardial infarction, stroke and renal complications. The need for early re-revascularization was significantly higher in OPCAB (pooled OR: 3.22, 95%CI: 1.28-8.09, P=0.01), with a 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). 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. As CABG on the elderly is still insufficiently explored, further RCTs, specifically designed targeting this population, are needed to establish a better CABG strategy for these patients.
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A 2021 study conducted a meta-analysis in Coronary artery disease requiring CABG (n=6,221). Off-pump CABG (OPCAB) vs. On-pump CABG (ONCAB) was evaluated on Mid-term mortality (HR 1.02, 95% CI 0.89-1.17, p=0.80). Off-pump CABG provided similar mid-term mortality compared to on-pump CABG in elderly patients (HR 1.02; 95% CI 0.89-1.17; P=0.80), but was associated with a higher risk of early re-revascularization.
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