Clinical Outcomes of On-Pump Versus Off-Pump Coronary-Artery Bypass Surgery: a Meta-Analysis

Background: The ongoing debate regarding off-pump CABG and on-pump CABG has endured for over three decades. Although numerous randomized controlled trials (RCTs) and meta-analyses have been reported, new evidence has emerged. Therefore, an updated and comprehensive meta-analysis to guide clinical practice is essential. Materials and Methods: A comprehensive search for eligible articles published after 2000, reporting RCTs involving at least 100 patients and comparing off-pump CABG with on-pump CABG, was performed throughout the databases including Embase, Ovid Medline and Web of Science. The primary interested outcomes included the short-term incidence of stroke and long-term mortality. The primary analysis utilized Fixed-effect model with the inverse variance method. The Grade of Recommendations Assessment, Development, and Evaluation (GRADE) was used to evaluate the certainty of evidence. Results: After thorough screening, 39 articles were included, consisting of 28 RCTs and involving a total of 16090 patients. Off-pump CABG significantly reduced the incidence of short-term stroke (1.27% vs. 1.78%, OR: 0.74, P=0.03, high certainty). However, it was observed to be associated with increased mid-term coronary reintervention (2.77% vs. 1.85%, RR: 1.49, P<0.01, high certainty) and long-term mortality (21.8% vs. 21.0%, RR: 1.09, P=0.02, moderate certainty). Conclusions: Off-pump CABG significantly reduces the short-term incidence of stroke, but it also increases the incidence of mid-term coronary reintervention. Moreover, it may increase long-term mortality.