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

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.