Analysis of survival after coronary endarterectomy combined with coronary artery bypass grafting compared with isolated coronary artery bypass grafting: a meta-analysis.

OBJECTIVES

The aim of this analysis was to compare survival outcomes of coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) with those of conventional CABG.

METHODS

Eight observational studies were included in this analysis, including 10 529 different patients in Asia, Europe and North America, from 1985 to 2012, among whom 1925 underwent CE + CAGB and 8604 underwent conventional CAGB. The follow-up period ranged from 4 to 14 years. This meta-analysis was performed with the fixed-effects model.

RESULTS

After rigorous assessment of the quality of the studies included, this analysis showed that CE + CABG had a statistically significant weaker short-term outcome, with a higher risk of mortality [odds ratio (OR)] 1.61; P = 0.002]. Further, this phenomenon was exacerbated in the midterm. One-year and 2-year results indicated that death was, respectively, 163% (OR 2.63; P < 0.001) and 133% (OR 2.60; P < 0.001) more likely to occur in the CE + CABG group. However, the long-term results indicated no difference between the 2 groups. The 4-year hazard ratio (1.13; P = 0.10) did not show significant differences between the groups, and the Kaplan-Meier survival curves had the same level and pattern.

CONCLUSIONS

CE + CABG had a significantly weaker short-term outcome than conventional CABG, and this trend continued in the midterm. The survival rate had the largest gap in the midterm. However, there was no significant difference between these 2 groups in the long run.