Effect of Age on Clinical Outcomes Following On-/Off-Pump Coronary Artery Bypass: MetaAnalysis and Meta-Regression

Abstract

Objective There is currently much debate about which patients would benefit more after on- or off-pump coronary artery bypass grafting (CABG). The aim of this meta-analysis and meta-regression is to investigate the effect of age on short-term clinical outcomes after these approaches. Methods To identify potential studies, systematic searches were carried out in the Excerpta Medica dataBASE (EMBASE), PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL). The search strategy included the key concepts of “cardiopulmonary bypass” AND “coronary artery bypass grafting” AND “off pump” OR “on pump”. This was followed by a meta-analysis and meta-regression investigating the effect of age on the incidences of stroke, myocardial infarction (MI), and mortality. Results Thirty-seven studies including 15,324 participants were analysed. Overall, there was a significant odds reduction for patients receiving off-pump CABG suffering a stroke (odds ratio [OR] 0.770, 95% confidence intervals [CI] 0.594, 0.998, P =0.048); however, when patients were subdivided according to different age bands, this difference disappeared. There were also no significant differences in the odds of mortality (OR 0.876, 95% CI 0.703, 1.093, P =0.241) or MI (OR 0.937, 95% CI 0.795, 1.105, P =0.439). Meta-regression analysis revealed no significant relationship between age and stroke ( P =0.652), age and mortality ( P =548), and age and MI ( P =0.464). Conclusion Patients undergoing CABG are becoming older and may suffer from multiple comorbidities increasing their risk profile. However, with respect to short-term clinical outcomes, the patient’s age does not help in determining whether off- or on-pump is superior.

Risk factors for cerebrovascular accident after isolated coronary artery bypass grafting in Veterans

“…1,21,26 The utilization of cardiopulmonary bypass in CABG, and whether this itself is a risk factor for stroke, has mixed findings. [27][28][29][30] Our study did not find a significant association between on-pump status and the risk for CVA. Other studies have similarly shown that on-pump status is not associated with a difference in the rate of postoperative stroke.…”

“…This trend was attributed to increasing literature suggesting that off-pump CABG did not show advantage over on-pump and led to incomplete revascularization across many major trials. 27,[29][30][31]34 One important limitation of note is this study's inability to assess carotid artery stenosis as a contributing risk factor to postoperative CVA. While carotid artery disease is included within the definition of preoperative cerebrovascular disease in VASQIP, there was no data available within this database that allowed for assessment of carotid disease specifically as an independent variable.…”

“…29,31 However, a 2018 meta-analysis showed a significant odds-reductions in patients undergoing off-pump bypass suffering a stroke. 30 Additionally, there has been some demonstrated benefit to off-pump CABG specifically in patients at a higher risk for postoperative stroke including the elderly and the those with a history of a CVA. 30,32 Overall, 17.5% of CABG cases were performed off-pump within our cohort.…”

“…30 Additionally, there has been some demonstrated benefit to off-pump CABG specifically in patients at a higher risk for postoperative stroke including the elderly and the those with a history of a CVA. 30,32 Overall, 17.5% of CABG cases were performed off-pump within our cohort. This rate is consistent with the trend shown in a 2013 study done by Bakaeen et al 33 thereafter.…”

Off‐pump versus on‐pump coronary artery bypass grafting for octogenarians: A meta‐analysis involving 146 372 patients

“… 8 , 9 The discrepancy in these conclusions may be due to differences in endpoint definitions. Mauldon et al 35 conducted a meta‐analysis to investigate the effect of age on outcomes after OPCABG or CCABG. They found that the patient's age had no bearing on the chosen surgical method in the short‐term (<30 days) mortality.…”