title: Is off-pump coronary artery bypass grafting superior to drug-eluting stents for the treatment of coronary artery disease? A meta-analysis of randomized and nonrandomized studies.
abstract: BACKGROUND
  As drug-eluting stent (DES) has almost overcome the disadvantage of frequent restenosis, off-pump coronary artery bypass grafting (OPCAB) has been introduced to avoid complications of cardiopulmonary bypass. However, which approach may promise better outcomes for patients with coronary artery disease remains controversial.
  
  
  METHODS
  Three databases were searched. The outcomes of interest were major adverse cardiac and cerebrovascular events (MACCE), all-cause death, target vessel revascularization (TVR), repeat revascularization (RRV), myocardial infarction (MI), and cerebrovascular events (CVE). The relative risk (RR) was calculated as the summary statistic.
  
  
  RESULTS
  11,452 patients from 22 studies were included, of which 4949 patients underwent OPCAB and 6503 patients received DES. The cumulative rates of MACCE (RR [95% CI]=0.43 [0.34, 0.54], P<0.00001), all-cause death (RR [95% CI]=0.56 [0.33, 0.96], P=0.03), TVR (RR [95% CI]=0.33 [0.21, 0.53], P<0.00001), RRV (RR [95% CI]=0.22 [0.11, 0.42], P<0.00001) and MI (RR [95% CI]=0.13 [0.05, 0.29], P<0.00001) at 3 years were all lower in OPCAB group. The incidences of in-hospital death (RR [95% CI]=1.31 [0.81, 2.13], P=0.27) and MI (RR [95% CI]=1.03 [0.60, 1.78], P=0.92) were not different between groups, but the rate of in-hospital CVE was lower (RR [95% CI]=2.6355 [1.0033, 6.9228], P=0.05) in DES group.
  
  
  CONCLUSIONS
  OPCAB presents better long-term outcomes of MACCE, all-cause mortality, TVR, RRV and MI but uncertain outcome of postoperative CVE without influencing the incidences of in-hospital death and MI.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
authors.forename: Di
authors.initials: D
authors.lastname: Lu
authors.affiliation: Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
authors.forename: Ximing
authors.initials: X
authors.lastname: Nie
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Wan
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
authors.forename: Shengping
authors.initials: S
authors.lastname: He
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
authors.forename: Songlin
authors.initials: S
authors.lastname: Du
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
authors.forename: Zhenkang
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. Electronic address: wang-wujun@163.com.
authors.forename: Wujun
authors.initials: W
authors.lastname: Wang
mesh_terms: D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D054855:Drug-Eluting Stents; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D016896:Treatment Outcome
keywords: Coronary artery disease; Drug-eluting stent; Meta-analysis; Observational cohort; Off-pump coronary artery bypass grafting; Randomized controlled trial