Efficacy and effectiveness of on-versus off-pump coronary artery bypass grafting: A meta-analysis of mortality and survival

被引:41
作者
Filardo, Giovanni [1 ,3 ,4 ]
Hamman, Baron L. [5 ]
da Graca, Briget [2 ,3 ]
Sass, Danielle M. [1 ]
Machala, Natalie J. [1 ]
Ismail, Safiyah [1 ]
Pollock, Benjamin D. [1 ,3 ]
Collinsworth, Ashley W. [2 ,3 ]
Grayburn, Paul A. [6 ]
机构
[1] Baylor Scott & White Hlth, Dept Epidemiol, Dallas, TX USA
[2] Baylor Scott & White Hlth, Ctr Clin Effectiveness, Dallas, TX USA
[3] Baylor Univ, Robbins Inst Hlth Policy & Res, Waco, TX 76798 USA
[4] Southern Methodist Univ, Dept Stat, Dallas, TX USA
[5] Baylor Univ, Med Ctr, Baylor Heart & Vasc Inst, Dept Cardiothorac Surg, Dallas, TX USA
[6] Baylor Univ, Med Ctr, Baylor Heart & Vasc Inst, Dept Cardiol, Dallas, TX USA
关键词
coronary artery bypass graft; mortality; meta-analysis; off-pump surgery; LONG-TERM SURVIVAL; HIGH-RISK PATIENTS; IN-HOSPITAL OUTCOMES; FOLLOW-UP; BEATING-HEART; RANDOMIZED-TRIAL; MYOCARDIAL REVASCULARIZATION; CARDIOPULMONARY BYPASS; MIDTERM OUTCOMES; SURGERY;
D O I
10.1016/j.jtcvs.2017.08.026
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Despite many studies comparing on-versus off-pump coronary artery bypass graft (CABG), there is no consensus as to whether one of these techniques offers patients better outcomes. Methods: We searched PubMed from inception to June 30, 2015, and identified additional studies from bibliographies of meta-analyses and reviews. We identified 42 randomized controlled trials (RCTs) and 31 rigorously adjusted observational studies (controlling for the Society of Thoracic Surgeons-recognized risk factors for mortality) reporting mortality for off-pump versus on-pump CABG at specified time points. Trial data were extracted independently by 2 researchers using a standardized form. Differences in probability of mortality (DPM) were estimated for the RCTs and observational studies separately and combined, for time points ranging from 30 days to 10 years. Results: RCT-only data showed no significant differences at any time point, whereas observational-only data and the combined analysis showed short-term mortality favored off-pump CABG (n = 1.2 million patients; 36 RCTs, 26 observational studies; DPM [95% confidence interval (CI)], -44.8% [-45.4%, -43.8%]) but that at 5 years it was associated with significantly greater mortality (n = 60,405 patients; 3 RCTs, 5 observational studies; DPM [95% CI], 10.0% [5.0%, 15.0%]). At 10 years, only observational data were available, and off-pump CABG showed significantly greater mortality (DPM [95% CI], 14.0% [11.0%, 17.0%]). Conclusions: Evidence from RCTs showed no differences between the techniques, whereas rigorously adjusted observational studies (with>1.1 million patients) and the combined analysis indicated that off-pump CABG offers lower short-term mortality but poorer long-term survival. These results suggest that, in real-world settings, greater operative safety with off-pump CABG comes at the expense of lasting survival gains.
引用
收藏
页码:172 / +
页数:13
相关论文
共 97 条
[1]   Off-pump vs. on-pump coronary artery bypass surgery: an updated meta-analysis and meta-regression of randomized trials [J].
Afilalo, Jonathan ;
Rasti, Mandana ;
Ohayon, Samuel M. ;
Shimony, Avi ;
Eisenberg, Mark J. .
EUROPEAN HEART JOURNAL, 2012, 33 (10) :1257-1267
[2]   Use of off-pump and on-pump CABG strategies in current clinical practice: The clinical outcomes assessment program of the state of Washington [J].
Aldea, GS ;
Goss, JR ;
Boyle, EM ;
Quinton, RR ;
Maynard, C .
JOURNAL OF CARDIAC SURGERY, 2003, 18 (03) :206-215
[3]   Early and midterm outcome after off-pump and on-pump surgery in Beating Heart Against Cardioplegic Arrest Studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials [J].
Angelini, GD ;
Taylor, FC ;
Reeves, BC ;
Ascione, R .
LANCET, 2002, 359 (9313) :1194-1199
[4]   Effects of on-and off-pump coronary artery surgery on graft patency, survival, and health-related quality of life: Long-term follow-up of 2 randomized controlled trials [J].
Angelini, Gianni D. ;
Culliford, Lucy ;
Smith, David K. ;
Hamilton, Mark C. K. ;
Murphy, Gavin J. ;
Ascione, Raimondo ;
Baumbach, Andreas ;
Reeves, Barnaby C. .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2009, 137 (02) :295-303
[5]  
[Anonymous], 2010, SURGERY, DOI DOI 10.1016/J.SURG.2009.06.030
[6]  
[Anonymous], 2012, REV MAN REVMAN COMP
[7]   Beating versus arrested heart revascularization: evaluation of myocardial function in a prospective randomized study [J].
Ascione, R ;
Lloyd, CT ;
Gomes, WJ ;
Caputo, M ;
Bryan, AJ ;
Angelini, GD .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 1999, 15 (05) :685-690
[8]   Radial artery versus saphenous vein conduits for coronary artery bypass surgery: forty years of competition - which conduit offers better patency? A systematic review and meta-analysis [J].
Athanasiou, Thanos ;
Saso, Srdjan ;
Rao, Christopher ;
Vecht, Joshua ;
Grapsa, Julia ;
Dunning, Joel ;
Lemma, Massimo ;
Casula, Roberto .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2011, 40 (01) :208-220
[9]   Perioperative Outcomes after On-and Off-Pump Coronary Artery Bypass Grafting [J].
Bakaeen, Faisal G. ;
Chu, Danny ;
Kelly, Rosemary F. ;
Holman, William L. ;
Jessen, Michael E. ;
Ward, Herbert B. .
TEXAS HEART INSTITUTE JOURNAL, 2014, 41 (02) :144-151
[10]   Performing Coronary Artery Bypass Grafting Off-Pump May Compromise Long-Term Survival in a Veteran Population [J].
Bakaeen, Faisal G. ;
Chu, Danny ;
Kelly, Rosemary F. ;
Ward, Herbert B. ;
Jessen, Michael E. ;
Chen, G. John ;
Petersen, Nancy J. ;
Holman, William L. .
ANNALS OF THORACIC SURGERY, 2013, 95 (06) :1952-1960