title: Off-pump versus on-pump coronary artery bypass surgery: meta-analysis and meta-regression of 13,524 patients from randomized trials.
abstract: BACKGROUND
  Most recent published meta-analysis of randomized controlled trials (RCTs) showed that off-pump coronary artery bypass graft surgery (CABG) reduces incidence of stroke by 30% compared with on-pump CABG, but showed no difference in other outcomes. New RCTs were published, indicating need of new meta-analysis to investigate pooled results adding these further studies.
  
  
  METHODS
  MEDLINE, EMBASE, CENTRAL/CCTR, SciELO, LILACS, Google Scholar and reference lists of relevant articles were searched for RCTs that compared outcomes (30-day mortality for all-cause, myocardial infarction or stroke) between off-pump versus on-pump CABG until May 2012. The principal summary measures were relative risk (RR) with 95% Confidence Interval (CI) and P values (considered statistically significant when <0.05). The RR's were combined across studies using DerSimonian-Laird random effects weighted model. Meta-analysis and meta-regression were completed using the software Comprehensive Meta-Analysis version 2 (Biostat Inc., Englewood, New Jersey, USA).
  
  
  RESULTS
  Forty-seven RCTs were identified and included 13,524 patients (6,758 for off-pump and 6,766 for on-pump CABG). There was no significant difference between off-pump and on-pump CABG groups in RR for 30-day mortality or myocardial infarction, but there was difference about stroke in favor to off-pump CABG (RR 0.793, 95% CI 0.660-0.920, P=0.049). It was observed no important heterogeneity of effects about any outcome, but it was observed publication bias about outcome "stroke". Meta-regression did not demonstrate influence of female gender, number of grafts or age in outcomes.
  
  
  CONCLUSIONS
  Off-pump CABG reduces the incidence of post-operative stroke by 20.7% and has no substantial effect on mortality or myocardial infarction in comparison to on-pump CABG. Patient gender, number of grafts performed and age do not seem to explain the effect of off-pump CABG on mortality, myocardial infarction or stroke, respectively.
authors.affiliation: Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco, Recife, PE, Brazil. michel_pompeu@yahoo.com.br
authors.forename: Michel Pompeu Barros de Oliveira
authors.initials: MP
authors.lastname: Sá
authors.forename: Paulo Ernando
authors.initials: PE
authors.lastname: Ferraz
authors.forename: Rodrigo Renda
authors.initials: RR
authors.lastname: Escobar
authors.forename: Wendell Nunes
authors.initials: WN
authors.lastname: Martins
authors.forename: Pablo César
authors.initials: PC
authors.lastname: Lustosa
authors.forename: Eliobas de Oliveira
authors.initials: Ede O
authors.lastname: Nunes
authors.forename: Frederico Pires
authors.initials: FP
authors.lastname: Vasconcelos
authors.forename: Ricardo Carvalho
authors.initials: RC
authors.lastname: Lima
mesh_terms: D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*