Abstract 19554: Is Coronary Artery Bypass Grafting (CABG) with Cardiopulmonary Bypass Support (On-pump) Superior to CABG Without Bypass Support (Off-pump) in the High-Risk?: A Meta-Analysis of Randomized Controlled Trials (RCTs)
Background: Data from RCTs regarding the efficacy of on- vs. off-pump CABG remain inconclusive. This is especially true of high-risk patient populations. Current practice guidelines from the ACC/AHA in collaboration with Thoracic Surgical Societies do not make specific recommendations for the choice of on- vs. off-pump CABG, but leave the decision to the primary operator. This study was undertaken to compare the efficacy of on- vs. off-pump CABG in higher surgical risk patients.
Methods: We selected RCTs comparing on- and off-pump CABG, focusing on high-risk patient populations. Studies were included if the patient population was described as “high-risk” or included “high-risk” features: European System of Cardiac Operative Risk Evaluation (EuroScore) >6, age >70 years, pre-existing renal insufficiency, history of stroke(s), and the presence of left ventricular dysfunction. A PubMed literature search was performed for all publications between 1/1/2000 and 12/31/2013 with search terms: on-pump, off-pump, coronary artery bypass, high-risk, left ventricular dysfunction, elderly, aged, and renal insufficiency. A total of 64 publications were screened, of which 9 articles met the inclusion criteria. We evaluated for the endpoints of cardiovascular (CV) and all-cause mortality, non-fatal myocardial infarction (MI), stroke, need for repeat revascularization, renal failure, and length of hospital stay (LOS).
Results: A total of 11,374 patients with a mean age of 70 years were enrolled. On-pump CABG was not associated with improved CV (RR 0.82; 95% CI 0.38-1.73) and all-cause mortality (RR 1.02; 95% CI 0.80-1.32). No statistically significant reduction seen in development of non-fatal MI (RR 1.17; 95% CI 0.78-1.75) and renal failure (RR 1.48; 95% CI 0.94-2.32), while the need for repeat revascularization by 1-year was reduced (RR 0.69; 95% 0.50-0.97). However, on-pump CABG was associated with an increased risk of stroke (RR 1.34; 95% 1.02-1.76) and LOS (mean difference 2.24 days; 95% CI 0.34-4.14).
Conclusion: In high-risk patients, on-pump CABG is associated with a reduced risk for repeat revascularization by 1-year but at a cost of increased risk of stroke and longer hospitalization. On-pump and off-pump CABG have comparable all-cause and CV mortality.
Author Disclosures: A. Yousif: None. D. Addison: None. N. Lakkis: None. T. Rosengart: None. Y. Birnbaum: None. S.S. Virani: None. I. Hamzeh: None. M. Alam: None.
- © 2014 by American Heart Association, Inc.