Kowalewski Mariusz, Pawliszak Wojciech, Malvindi Pietro Giorgio, Bokszanski Marek Pawel, Perlinski Damian, Raffa Giuseppe Maria, Kowalkowska Magdalena Ewa, Zaborowska Katarzyna, Navarese Eliano Pio, Kolodziejczak Michalina, Kowalewski Janusz, Tarelli Giuseppe, Taggart David Paul, Anisimowicz Lech
Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland; Faculty of Health Sciences, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland; Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network, Düsseldorf, Germany.
Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital, Bydgoszcz, Poland.
J Thorac Cardiovasc Surg. 2016 Jan;151(1):60-77.e1-58. doi: 10.1016/j.jtcvs.2015.08.042. Epub 2015 Aug 15.
To assess the benefits and risks of off-pump coronary artery bypass (OPCAB) versus coronary artery bypass grafting (CABG) through a meta-analysis of randomized controlled trials (RCTs), and to investigate the relationship between outcomes and patient risk profile.
PubMed, Embase, the Cumulative Index of Nursing and Allied Health Literature, Scopus, Web of Science, Cochrane Library, and major conference proceedings databases were searched for RCTs comparing OPCAB and CABG and reporting short-term (≤ 30 days) outcomes. Endpoints assessed were all-cause mortality, myocardial infarction (MI), and cerebral stroke.
The meta-analysis included 100 studies, with a total of 19,192 subjects. There was no difference between the 2 techniques with respect to all-cause mortality and MI (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.71-1.09; P = .25; I(2) = 0% and OR, 0.90; 95% CI, 0.77-1.05; P = .19; I(2) = 0%, respectively). OPCAB was associated with a significant 28% reduction in the odds of cerebral stroke (OR, 0.72; 95% CI, 0.56-0.92; P = .009; I(2) = 0%). A significant relationship between patient risk profile and benefits from OPCAB was found in terms of all-cause mortality (P < .01), MI (P < .01), and cerebral stroke (P < .01).
OPCAB is associated with a significant reduction in the odds of cerebral stroke compared with conventional CABG. In addition, benefits of OPCAB in terms of death, MI, and cerebral stroke are significantly related to patient risk profile, suggesting that OPCAB should be strongly considered in high-risk patients.
通过对随机对照试验（RCT）的荟萃分析，评估非体外循环冠状动脉搭桥术（OPCAB）与冠状动脉搭桥术（CABG）的获益与风险，并研究结局与患者风险特征之间的关系。
检索了PubMed、Embase、护理及相关健康文献累积索引、Scopus、科学引文索引、Cochrane图书馆以及主要会议论文数据库，以查找比较OPCAB和CABG并报告短期（≤30天）结局的RCT。评估的终点为全因死亡率、心肌梗死（MI）和脑卒中。
荟萃分析纳入了100项研究，共19192名受试者。两种技术在全因死亡率和MI方面无差异（优势比[OR]为0.88；95%置信区间[CI]为0.71 - 1.09；P = 0.25；I² = 0%；OR为0.90；95%CI为0.77 - 1.05；P = 0.19；I² = 0%）。OPCAB与脑卒中几率显著降低28%相关（OR为0.72；95%CI为0.56 - 0.92；P = 0.009；I² = 0%）。在全因死亡率（P < 0.01）、MI（P < 0.01）和脑卒中（P < 0.01）方面，发现患者风险特征与OPCAB的获益之间存在显著关系。
与传统CABG相比，OPCAB与脑卒中几率显著降低相关。此外，OPCAB在死亡、MI和脑卒中方面的获益与患者风险特征显著相关，这表明高危患者应强烈考虑行OPCAB。
