Takagi Hisato, Umemoto Takuya
Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
J Thorac Cardiovasc Surg. 2014 Nov;148(5):1820-9. doi: 10.1016/j.jtcvs.2014.05.034. Epub 2014 May 21.
To determine whether off-pump coronary artery bypass grafting (CABG) is associated with worse long-term survival compared with on-pump CABG. We performed a meta-analysis of adjusted observational studies and randomized controlled trials.
MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through March 2014. Eligible studies were randomized controlled trials and adjusted observational studies (in which appropriate statistical methods adjusting for confounders had been used) of off-pump versus on-pump CABG that had reported long-term (≥5-year) all-cause mortality as an outcome.
Of 478 potentially relevant studies screened initially, 5 randomized trials and 17 observational studies, enrolling a total of 104,306 patients, were identified and included. A pooled analysis of all 22 studies demonstrated a statistically significant 7% increase in long-term all-cause mortality with off-pump relative to on-pump CABG (hazard ratio, 1.07; 95% confidence interval, 1.03-1.11; P=.0003). Although a pooled analysis of 5 randomized trials (1486 patients) demonstrated a statistically nonsignificant 14% increase in mortality with off-pump relative to on-pump CABG (hazard ratio, 1.14; 95% confidence interval, 0.84-1.56; P=.39), another pooled analysis of 17 observational studies (102,820 patients) demonstrated a statistically significant 7% increase in mortality with off-pump relative to on-pump CABG (hazard ratio, 1.07; 95% confidence interval, 1.03-1.11; P=.0004).
A meta-analysis of 22 studies, enrolling a total of >100,000 patients, showed that off-pump CABG is likely associated with worse long-term (≥5-year) survival compared with on-pump CABG.
确定与体外循环冠状动脉旁路移植术（CABG）相比，非体外循环冠状动脉旁路移植术是否与更差的长期生存率相关。我们对校正后的观察性研究和随机对照试验进行了荟萃分析。
检索截至2014年3月的MEDLINE、EMBASE和Cochrane对照试验中央注册库。符合条件的研究为非体外循环与体外循环CABG的随机对照试验和校正后的观察性研究（其中使用了适当的统计方法对混杂因素进行校正），这些研究将长期（≥5年）全因死亡率作为结局指标进行了报告。
在最初筛选的478项可能相关的研究中，确定并纳入了5项随机试验和17项观察性研究，共纳入104,306例患者。对所有22项研究的汇总分析显示，与体外循环CABG相比，非体外循环CABG的长期全因死亡率有统计学意义地增加了7%（风险比，1.07；95%置信区间，1.03 - 1.11；P = 0.0003）。虽然对5项随机试验（1486例患者）的汇总分析显示，与体外循环CABG相比，非体外循环CABG的死亡率有统计学意义地增加了14%（风险比，1.14；95%置信区间，0.84 - 1.56；P = 0.39），但对17项观察性研究（102,820例患者）的另一项汇总分析显示，与体外循环CABG相比，非体外循环CABG的死亡率有统计学意义地增加了7%（风险比，1.07；95%置信区间，1.03 - 1.11；P = 0.0004）。
对总共纳入超过100,000例患者的22项研究进行的荟萃分析表明，与体外循环CABG相比，非体外循环CABG可能与更差的长期（≥5年）生存率相关。
