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Meta-Analysis Comparing ≥10-Year Mortality of Off-Pump Versus On-Pump Coronary Artery Bypass Grafting

  • Author Footnotes
    † The first and second authors (H. Takagi and T. Ando) contributed equally to this study and share the first authorship.
    Hisato Takagi
    Correspondence
    Corresponding author: Tel: (+81) 55 975 2000; fax: (+81) 55 975 2725.
    Footnotes
    † The first and second authors (H. Takagi and T. Ando) contributed equally to this study and share the first authorship.
    Affiliations
    Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
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  • Author Footnotes
    † The first and second authors (H. Takagi and T. Ando) contributed equally to this study and share the first authorship.
    Tomo Ando
    Footnotes
    † The first and second authors (H. Takagi and T. Ando) contributed equally to this study and share the first authorship.
    Affiliations
    Department of Cardiology, Detroit Medical Center, Detroit, Michigan
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  • Shohei Mitta
    Affiliations
    Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
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  • for theALICE (All-Literature Investigation of Cardiovascular Evidence) group
  • Author Footnotes
    † The first and second authors (H. Takagi and T. Ando) contributed equally to this study and share the first authorship.
      Off-pump coronary artery bypass grafting (CABG) is suggested to be associated with an increase in long-term (≥5-year) all-cause mortality. To determine whether off-pump CABG is associated with an increase in very long-term (≥10-year) all-cause mortality, we performed a meta-analysis of propensity-score matched observational comparative studies of off-pump versus on-pump CABG. MEDLINE and EMBASE were searched through May 2017. A hazard ratio of follow-up (including early) all-cause mortality for off-pump versus on-pump CABG was extracted from each individual study. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic hazard ratios in the random-effects model. Of 164 potentially relevant studies, our search identified 16 propensity-score matched observational comparative studies of off-pump versus on-pump CABG with ≥10-year follow-up enrolling a total of 82,316 patients. A pooled analysis of all the 16 studies demonstrated that off-pump CABG was significantly associated with an increase in all-cause mortality (hazard ratio 1.07, 95% confidence interval 1.03 to 1.12, p for effect = 0.0008; p for heterogeneity = 0.30, I2 = 12%). In a sensitivity analysis, exclusion of any single hazard ratio from the analysis (leave-one-out meta-analysis) did not substantively alter the overall result. There was no evidence of a significant publication bias. In conclusion, off-pump CABG is associated with an increase in very long-term (≥10 years) all-cause mortality compared with on-pump CABG.
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