title: Off-pump versus on-pump coronary artery bypass grafting in patients with diabetes: a meta-analysis.
abstract: OBJECTIVE
  The effects of off-pump CABG (OFF-CABG) versus on-pump CABG (ON-CABG) in diabetic patients remain controversial. The aim of our study was to compare mortality and postoperative morbidity between OFF-CABG and ON-CABG for diabetic patients.
  
  
  METHODS
  Electronic databases including PubMed, EMBASE and Cochrane Library for studies investigating clinical outcomes of OFF-CABG versus ON-CABG in diabetic patients were searched, collecting data from inception until June 2016. We pooled the odds ratios from individual studies and performed heterogeneity, quality assessment and publication bias analysis.
  
  
  RESULTS
  A total of 543,220 diabetic patients in 10 studies were included. The overall mortality (OR, 0.87; 95% CI, 0.58-1.31; p = 0.50) was comparable between the OFF-CABG and ON-CABG. OFF-CABG was associated with significantly fewer cerebrovascular accidents (OR, 0.45; 95% CI, 0.31-0.65; p < 0.0001), bleeding complications (OR, 0.59; 95% CI, 0.43-0.80; p < 0.001) and pulmonary complications. However, no differences in myocardial infarction (OR, 0.76; 95% CI, 0.52-1.12; p = 0.16), renal failure (OR, 0.74; 95% CI, 0.50-1.11; p = 0.14) and other postoperative morbidity outcomes were found.
  
  
  CONCLUSIONS
  OFF-CABG significantly reduces the incidence of postoperative cerebrovascular accidents and bleeding complications compared with ON-CABG in diabetic patients. No differences were found regarding mortality, myocardial infarction and renal failure between these two techniques. Our study suggests that OFF-CABG may be an optimal strategy for diabetic patients although adequately powered randomized trials are needed to further verify the finding.
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
authors.forename: Yushu
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
authors.forename: Xiuli
authors.initials: X
authors.lastname: Shi
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
authors.forename: Rongsheng
authors.initials: R
authors.lastname: Du
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
authors.forename: Yucheng
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China. zhangqingdoc@126.com.
authors.forename: Qing
authors.initials: Q
authors.lastname: Zhang
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D047549:Coronary Artery Bypass, Off-Pump / Q000401:mortality; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D003925:Diabetic Angiopathies / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D020521:Stroke / Q000150:complications / Q000401:mortality / Q000601:surgery; D016896:Treatment Outcome
keywords: Clinical outcomes; Coronary heart disease; Diabetes; Off-pump coronary artery bypass grafting; On-pump coronary artery bypass grafting