Comparative efficacy on outcomes of C-CABG, OPCAB and ONBEAT in coronary heart disease: A systematic review and network meta-analysis of randomized controlled trials.

Abstract

IMPORTANCE:

Coronary artery bypass grafting (CABG) remains the gold standard for the treatment of multivessel and left main coronary heart disease. However, the current evidence about the optimal surgical revascularization strategy is inconsistent and is not sufficient to allow for definite conclusions. Thus, this topic needs to be extensively discussed.

OBJECTIVE:

The aim of this present study was to compare the clinical outcomes of off-pump CABG (OPCAB), conventional on-pump CABG (C-CABG) and on-pump beating heart (ONBEAT) CABG via an updated systematic review and network meta-analysis of randomized controlled trials (RCTs).

DATA SOURCES:

PubMed, Web of Science and the Cochrane Central Registry were searched for relevant RCTs that were published in English before December 1, 2021.

STUDY SELECTION:

Published trials that included patients who received OPCAB, C-CABG and ONBEAT CABG were selected.

DATA EXTRACTION AND SYNTHESIS:

Two authors independently screened the search results, assessed the full texts to identify eligible studies and the risk of bias of the included studies, and extracted data. All processes followed the Preferred Reporting Items for Systematic Review and Meta-analysis of Individual Participant Data.

MAIN OUTCOMES AND MEASURES:

The primary outcome was postoperative mortality in patients who underwent C-CABG, OPCAB or ONBEAT CABG. The secondary outcomes were postoperative myocardial infarction, stroke, and renal impairment in the three groups. The time point for analysis of outcomes was all time periods during the postoperative follow-up.

RESULTS:

A total of 39385 patients (83,496.2 person-years) in 65 studies who fulfilled the prespecified criteria were included. In the network meta-analysis, OPCAB was associated with an increase of 12% in the risk of all-cause mortality when compared with C-CABG (OR: 1.12; 95% CI: 1.04 to 1.21), a reduction of 49% in the risk of myocardial infarction when compared with ONBEAT (OR: 0.51; 95% CI: 0.26 to 0.99), a reduction of 16% in the risk of stroke when compared with C-CABG (OR: 0.84; 95% CI: 0.72 to 0.99) and a similar risk of renal impairment when compared with C-CABG and ONBEAT.

CONCLUSIONS AND RELEVANCE:

OPCAB was associated with higher all-cause mortality but lower postoperative stroke compared with C-CABG. OPCAB was associated with lower postoperative myocardial infarction than that of ONBEAT. Early mortality was comparable among OPCAB, ONBEAT and C-CABG.

• Authors: Lin Zhu, Dongjie Li, Xu Zhang, Sitong Wan, Yuyong Liu, HongJia Zhang, Junjie Luo, Yongting Luo, Peng An, Wenjian Jiang
• Journal: International journal of surgery (London, England) (Int J Surg) (Sep 18 2023) ISSN: 1743-9159 [Electronic] United States
• PMID: 37720926 (Publication Type: Journal Article)
• Copyright: Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.