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Review
. 2024 Jul 11.
doi: 10.1007/s10557-024-07603-y. Online ahead of print.

Off-pump Versus On-pump Coronary Artery Bypass Grafting in Diabetic patients: A Meta-analysis of Observational Studies with a Propensity-Score Analysis

Qiushi Ren  1   2 , Gang Li  1   2 , Tongxin Chu  1   2 , Quan Liu  1   2 , Yang Huang  1   2 , KaiZheng Liu  1   2 , Jinyu Pan  1   2 , Zhongkai Wu  3   4
Affiliations
Review

Off-pump Versus On-pump Coronary Artery Bypass Grafting in Diabetic patients: A Meta-analysis of Observational Studies with a Propensity-Score Analysis

Qiushi Ren et al. Cardiovasc Drugs Ther. .

Abstract

Purpose: The debate between off-pump coronary artery bypass grafting (OPCAB) and on-pump coronary artery bypass grafting (ONCAB) in diabetic patients remains. This meta-analysis aimed to investigate outcomes after OPCAB versus ONCAB for patients with diabetes.

Methods: Literature research was conducted up to December 2023 using Ovid Medline, EMBASE, and the Cochrane Library. Eligible studies were observational studies with a propensity-score analysis of OPCAB versus ONCAB. The primary outcomes were early mortality and mid-term survival. The secondary outcomes were cerebrovascular accidents, reoperation for bleeding, incomplete revascularization, myocardial infarction, low cardiac output, and renal replacement therapy.

Results: Our research identified seven observational studies with a propensity-score analysis enrolling 13,085 patients. There was no significant difference between OPCAB and ONCAB for early mortality, mid-term survival, myocardial infarction, low cardiac output, and renal replacement therapy. OPCAB was associated with a lower risk of cerebrovascular accidents (OR 0.43; 95% CI, 0.24-0.76, P = 0.004) and reoperation for bleeding (OR 0.60; 95% CI, 0.41-0.88, P = 0.009). However, OPCAB was associated with a higher risk of incomplete revascularization (OR 2.07; 95% CI, 1.60-2.68, P < 0.00001).

Conclusion: Among patients with diabetes, no difference in early mortality and mid-term survival was observed. However, OPCAB was associated with a lower incidence of morbidity, including cerebrovascular accidents and reoperation for bleeding.

Keywords: Cerebrovascular accident; Coronary artery bypass grafting; Diabetes; Mortality; Off-pump; On-pump.

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