Ahmed Muhammad, Majeed Kanwal, Ali Hassam, Syed Hina, Batool Atiya
Department of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan.
Int Urol Nephrol. 2025 Feb;57(2):463-477. doi: 10.1007/s11255-024-04198-z. Epub 2024 Sep 9.
In patients with chronic kidney disease (CKD), cardiovascular disease is found to be the primary cause of mortality, and after coronary artery bypass grafting (CABG), their prognosis deteriorates.
We conducted a meta-analysis comparing off-pump CABG versus on-pump CABG in CKD patients. We searched electronic databases, including PubMed, Cochrane, and Google Scholar, using relevant keywords. We included studies comparing off-pump CABG with on-pump CABG in patients with chronic kidney disease, which was defined as an estimated glomerular filtration rate (eGFR) < 60 ml/min per 1.73 m. Effect estimates were synthesized using a random-effects model and expressed as risk ratios (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, with corresponding 95% confidence intervals (CIs). Our primary outcome was short-term mortality.
A total of 25 studies, of which 23 were observational and 2 were RCTs, were included in this meta-analysis, comprising 234,585 patients (66,591 in the off-pump group and 167,994 in the on-pump group). Our meta-analysis showed that there was a significantly higher mortality rate in the on-pump CABG group as compared to the off-pump CABG group (RR: 0.73, 95% CI [0.61, 0.88]; P = 0.0006, I = 60%).
Compared with OPCAB, short-term mortality was significantly higher in ONCAB.
在慢性肾脏病（CKD）患者中，心血管疾病是主要死因，且冠状动脉旁路移植术（CABG）后，其预后会恶化。
我们进行了一项荟萃分析，比较CKD患者非体外循环冠状动脉旁路移植术（OPCAB）与体外循环冠状动脉旁路移植术（ONCAB）。我们使用相关关键词搜索了包括PubMed、Cochrane和谷歌学术在内的电子数据库。我们纳入了比较慢性肾脏病患者（定义为估计肾小球滤过率（eGFR）<60 ml/min/1.73m²）的OPCAB与ONCAB的研究。效应估计值采用随机效应模型进行综合，二分结局以风险比（RR）表示，连续结局以均值差（MD）表示，并给出相应的95%置信区间（CI）。我们的主要结局是短期死亡率。
本荟萃分析共纳入25项研究，其中23项为观察性研究，2项为随机对照试验，共234,585例患者（非体外循环组66,591例，体外循环组167,994例）。我们的荟萃分析表明，与非体外循环冠状动脉旁路移植术组相比，体外循环冠状动脉旁路移植术组的死亡率显著更高（RR：0.73，95%CI[0.61,0.88]；P=0.0006，I²=60%）。
与OPCAB相比，ONCAB的短期死亡率显著更高。
