title: Meta-analysis of randomized trials comparing the effectiveness of on-pump and off-pump coronary artery bypass.
abstract: BACKGROUND
  The growing enthusiasm for coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) is emerging, but the role of off-pump coronary artery bypass (OPCAB) in clinical practice remains controversial. The purpose of this study was to assess differences in the incidences of stroke, atrial fibrillation (AF), and myocardial infarction (MI) between OPCAB and conventional coronary artery bypass grafting (CCABG) by meta-analyses of randomized clinical trials.
  
  
  METHODS
  A literature search for the period before March 2010 supplemented with manual bibliographic review was performed for all Chinese or English publications in Medline, the Science Citation Index Expanded, the Cochrane Central Register of Controlled Trials (CENTRAL) and CBMdisc. A systematic overview (meta-analyses) of randomized clinical trials was conducted to evaluate the differences between OPCAB and CCABG in the incidences of stroke, AF, and MI. The meta-analysis was performed using RevMan 5 software.
  
  
  RESULTS
  Forty-three randomized clinical trials were selected for meta-analysis after screening a total of 356 references, with 8104 patients in the OPCAB group and 8724 cases in the CCABG group. The meta-analyses of these trials showed no significant difference between OPCAB and CCABG in the incidences of stroke (odds ratio (OR) = 0.80, 95% confidence interval (CI) = 0.52 - 1.22, P = 0.30) and MI (OR = 0.73, 95%CI = 0.52 - 1.02, P = 0.06). However, we found a significantly reduced risk of AF (OR = 0.65, 95%CI = 0.52 - 0.82, P = 0.0002) in off-pump patients.
  
  
  CONCLUSIONS
  Our meta-analyses suggest that OPCAB reduces the risk of postoperative AF compared with CCABG, but there is no significant difference in the incidences of stroke and MI between OPCAB and CCABG.
authors.affiliation: Department of Cardiothoracic Surgery, Second Affiliated Hospital, Soochow University, Suzhou, Jiangsu 215004, China.
authors.forename: Yong-Bing
authors.initials: YB
authors.lastname: Chen
authors.forename: Jian
authors.initials: J
authors.lastname: Shu
authors.forename: Wen-Tao
authors.initials: WT
authors.lastname: Yang
authors.forename: Li
authors.initials: L
authors.lastname: Shi
authors.forename: Xu-Feng
authors.initials: XF
authors.lastname: Guo
authors.forename: Fei-Ge
authors.initials: FG
authors.lastname: Wang
authors.forename: Yong-Yue
authors.initials: YY
authors.lastname: Qian
mesh_terms: D001281:Atrial Fibrillation; D001026:Coronary Artery Bypass; D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D016032:Randomized Controlled Trials as Topic; D020521:Stroke; D016896:Treatment Outcome