title: Off-pump versus on-pump coronary artery bypass: meta-analysis of currently available randomized trials.
abstract: BACKGROUND
  Off-pump coronary artery bypass (OPCAB) challenges the conventional on-pump coronary artery bypass grafting (CABG) as the standard of surgical therapy for coronary disease. The aim of this study is to assess the differences in clinical outcomes between CABG and OPCAB by meta-analysis of data published in randomized trials.
  
  
  METHODS
  A literature search (Medline, Pubmed, Cochrane Controlled Trials Register, and the Cochrane Medical Editors Trial Amnesty of unpublished clinical trials) was done for the period starting from January 1990 until May 2002 and was supplemented with a manual bibliographic review for all peer-reviewed English language publications. A systematic overview (meta-analysis) of the randomized trials was done to define the risk of the composite end point (death, stroke, or myocardial infarction) in CABG versus OPCAB.
  
  
  RESULTS
  A literature search yielded nine comparable randomized studies, for a total of 1090 patients, of whom 558 and 532 were randomly assigned to CABG and OPCAB, respectively. Meta-analysis of these studies showed a trend, albeit not statistically significant, toward reduction in the risk of the composite end point for patients who had OPCAB (odds ratio 0.48; 95% confidence interval 0.21 to 1.09; p = 0.08).
  
  
  CONCLUSIONS
  Cumulative analysis of the few prospective randomized studies currently available found a potential clinical benefit of OPCAB, indicating that the avoidance of extracorporeal circulation might result in improved clinical outcomes. Further evidence, however, from large randomized trials is needed to assess potential advantages of OPCAB in terms of early outcomes.
authors.affiliation: Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Milan, Italy. aparolari@cardiologicomonzino.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Parolari
authors.forename: Francesco
authors.initials: F
authors.lastname: Alamanni
authors.forename: Aldo
authors.initials: A
authors.lastname: Cannata
authors.forename: Moreno
authors.initials: M
authors.lastname: Naliato
authors.forename: Luigi
authors.initials: L
authors.lastname: Bonati
authors.forename: Patrizia
authors.initials: P
authors.lastname: Rubini
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Veglia
authors.forename: Elena
authors.initials: E
authors.lastname: Tremoli
authors.forename: Paolo
authors.initials: P
authors.lastname: Biglioli
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003327:Coronary Disease / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome