Wang Yushu, Shi Xiuli, Du Rongsheng, Chen Yucheng, Zhang Qing
Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
Acta Diabetol. 2017 Mar;54(3):283-292. doi: 10.1007/s00592-016-0951-0. Epub 2016 Dec 30.
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.
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.
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.
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.
非体外循环冠状动脉旁路移植术（OFF-CABG）与体外循环冠状动脉旁路移植术（ON-CABG）在糖尿病患者中的疗效仍存在争议。本研究的目的是比较糖尿病患者接受OFF-CABG和ON-CABG后的死亡率和术后发病率。
检索包括PubMed、EMBASE和Cochrane图书馆在内的电子数据库，以查找研究OFF-CABG与ON-CABG在糖尿病患者中临床结局的研究，收集从开始到2016年6月的数据。我们汇总了各个研究的比值比，并进行了异质性、质量评估和发表偏倚分析。
10项研究共纳入543,220例糖尿病患者。OFF-CABG和ON-CABG的总体死亡率（比值比，0.87；95%置信区间，0.58 - 1.31；p = 0.50）相当。OFF-CABG与显著较少的脑血管意外（比值比，0.45；95%置信区间，0.31 - 0.65；p < 0.0001）、出血并发症（比值比，0.59；95%置信区间，0.43 - 0.80；p < 0.001）和肺部并发症相关。然而，在心肌梗死（比值比，0.76；95%置信区间，0.52 - 1.12；p = 0.16）、肾衰竭（比值比，0.74；95%置信区间，0.50 - 1.11；p = 0.14）和其他术后发病结局方面未发现差异。
与ON-CABG相比，OFF-CABG可显著降低糖尿病患者术后脑血管意外和出血并发症的发生率。在这两种技术之间，死亡率、心肌梗死和肾衰竭方面未发现差异。我们的研究表明，尽管需要足够大样本量的随机试验来进一步验证这一发现，但OFF-CABG可能是糖尿病患者的最佳策略。
