Skip to main content
SpringerLink
Log in

Incidence of atrial fibrillation after off-pump versus on-pump coronary artery bypass grafting: A meta-analysis of randomized clinical trials and propensity score matching trials

  • Published:
Current Medical Science Aims and scope Submit manuscript

Summary

The association between atrial fibrillation (AF) after coronary artery bypass grafting (CABG) and the surgical techniques selected has been extensively reported. However, no consistent results were obtained. In the present study, a meta-analysis was conducted by searching the electronic databases PubMed, Embase, Web of Science, and Cochrane to identify the association of post-CABG AF with on-pump (conventional CABG, cCABG) or off-pump CABG (OPCABG). Outcomes from randomized clinical trials (RCTs) and propensity score matching (PSM) trials were pooled by using the fixed-effect or the random-effect modeling method, and verified by the quality-effect modeling method. There were 35 studies with 36 independent reports that met the inclusion criteria and were eventually included in our meta-analysis. The total odds ratio (OR) of the incidence of post-CABG AF between OPCABG and cCABG was 0.80 (95% CI 0.71–0.91). The 25 randomized clinical trials (RCTs) had an OR of 0.69 (95% CI 0.56–0.86), while the OR of the 11 PSM trials was 0.88 (95% CI 0.77–1.00). Twenty-six studies involving the patients at a mean age no more than 65 years showed an OR of 0.76 (95% CI 0.64–0.90), whereas 10 studies with patients greater than 65 years old showed an OR of 0.90 (95% CI 0.78–1.05). The results of this meta-analysis suggest that OPCAB surgery may reduce the incidence of post-CABG AF when compared to cCABG and that younger patients may benefit more from OPCAB and have a lower incidence of post-CABG AF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Villareal RP, Hariharan R, Liu BC, et al. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol, 2004,43(5):742–748

    Article  PubMed  Google Scholar 

  2. Amar D, Shi W, Hogue CW, et al. Clinical prediction rule for atrial fibrillation after coronary artery bypass grafting. J Am Coll Cardiol, 2004,44(6):1248–1253

    Article  PubMed  Google Scholar 

  3. Creswell LL. Postoperative atrial arrhythmias: risk factors and associated adverse outcomes. Semin Thorac Cardiovasc Surg, 1999,11(4):303–307

    Article  PubMed  CAS  Google Scholar 

  4. Almassi GH, Schowalter T, Nicolosi AC, et al. Atrial fibrillation after cardiac surgery: a major morbid event? Ann Surg, 1997,226(4):501–511

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  5. Aranki SF, Shaw DP, Adams DH, et al. Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources. Circulation, 1996,94(3):390–397

    PubMed  CAS  Google Scholar 

  6. Maisel WH, Rawn JD, Stevenson WG. Atrial fibrillation after cardiac surgery. Ann Intern Med, 2001,135(12):1061–1073

    Article  PubMed  CAS  Google Scholar 

  7. Archbold RA, Curzen NP. Off-pump coronary artery bypass graft surgery: the incidence of postoperative atrial fibrillation. Heart, 2003,89(10):1134–1137

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. Alex J, Bhamra GS, Cale AR, et al. Atrial fibrillation after coronary bypass surgery–pathophysiology, resource utilisation and management strategies. Br J Cardiol, 2003,10(11):82–88

    Google Scholar 

  9. Head SJ, Börgermann J, Osnabrugge RL, et al. Coronary artery bypass grafting: part 2—Optimizing outcomes and future prospects. Eur Heart J, 2013,34(37):2873–2886

    Article  PubMed  Google Scholar 

  10. Roffman JA, Fieldman A. Digoxin and propranolol in the prophylaxis of supraventricular tachydysrhythmias after coronary artery bypass surgery. Ann Thorac Surg, 1981,31(6):496–501

    Article  PubMed  CAS  Google Scholar 

  11. Møller CH, Penninga L, Wetterslev J, et al. Clinical outcomes in randomized trials of off-vs. on-pump coronary artery bypass surgery: systematic review with meta-analyses and trial sequential analyses. Eur Heart J, 2008,29(21):2601–2616

    Article  PubMed  Google Scholar 

  12. Sedrakyan A, Wu AW, Parashar A, et al. Off-pump surgery is associated with reduced occurrence of stroke and other morbidity as compared with traditional coronary artery bypass grafting: a meta-analysis of systematically reviewed trials. Stroke, 2006,37(11):2759–2769

    Article  PubMed  Google Scholar 

  13. Al-Ruzzeh S, Nakamura K, Athanasiou T, et al. Does off-pump coronary artery bypass (OPCAB) surgery improve the outcome in high-risk patients?: a comparative study of 1398 high-risk patients. Eur J Cardiothorac Surg, 2003,23(1):50–55

    Article  PubMed  Google Scholar 

  14. Hoff SJ, Ball SK, Coltharp WH, et al. Coronary artery bypass in patients 80 years and over: is off-pump the operation of choice? Ann Thorac Surg, 2002,74(4):S1340–S1343

    Article  PubMed  Google Scholar 

  15. Blettner M, Sauerbrei W, Schlehofer B, et al. Traditional reviews, meta-analyses and pooled analyses in epidemiology. Int J Epidemiol, 1999,28(1):1–9

    Article  PubMed  CAS  Google Scholar 

  16. Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Lancet, 1999,354(9193):1896–1900

    Article  PubMed  CAS  Google Scholar 

  17. Heyland DK, MacDonald S, Keefe L, et al. Total parenteral nutrition in the critically ill patient: a meta-analysis. JAMA, 1998,280(23):2013–2019

    Article  PubMed  CAS  Google Scholar 

  18. Heyland DK, Cook DJ, King D, et al. Maximizing oxygen delivery in critically ill patients: a methodologic appraisal of the evidence. Crit Care Med, 1996,24(3):517–524

    Article  PubMed  CAS  Google Scholar 

  19. Lau J, Ioannidis JP, Schmid CH. Quantitative synthesis in systematic reviews. Ann Intern Med, 1997,127(9):820–826

    Article  PubMed  CAS  Google Scholar 

  20. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ, 2003,327(7414):557–560

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kuss O, von Salviati B, Börgermann J. Off-pump versus on-pump coronary artery bypass grafting: a systematic review and meta-analysis of propensity score analyses. J Thorac Cardiovasc Surg, 2010,140(4):829–835

    Article  PubMed  Google Scholar 

  22. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics, 1994,50(4):1088–1101

    Article  PubMed  CAS  Google Scholar 

  23. Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ, 1997,315(7109):629–634

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. Alamanni F, Dainese L, Naliato M, et al. On-and off-pump coronary surgery and perioperative myocardial infarction: an issue between incomplete and extensive revascularization. Eur J Cardiothorac Surg, 2008,34(1):118–126

    Article  PubMed  Google Scholar 

  25. Almassi GH, Pecsi SA, Collins JF, et al. Predictors and impact of postoperative atrial fibrillation on patients' outcomes: a report from the randomized on versus off bypass trial. J Thorac Cardiovasc Surg, 2012,143(1):93–102

    Article  PubMed  Google Scholar 

  26. Al-Ruzzeh S, George S, Bustami M, et al. Effect of off-pump coronary artery bypass surgery on clinical, angiographic, neurocognitive, and quality of life outcomes: randomised controlled trial. BMJ, 2006,332(7554):1365

    Article  PubMed  PubMed Central  Google Scholar 

  27. Angelini GD, Taylor FC, Reeves BC, et al. Early and midterm outcome after off-pump and on-pump surgery in beating heart against cardioplegic arrest studies (BHACAS 1 and 2): a pooled analysis of two randomised controlled trials. Lancet, 2002,359(9313):1194–1199

    Article  PubMed  Google Scholar 

  28. Ascione R, Narayan P, Rogers CA, et al. Early and midterm clinical outcome in patients with severe left ventricular dysfunction undergoing coronary artery surgery. Ann Thorac Surg, 2003,76(3):793–799

    Article  PubMed  Google Scholar 

  29. Attaran S, Shaw M, Bond L, et al. Does off-pump coronary artery revascularization improve the long-term survival in patients with ventricular dysfunction? Interact Cardiovasc Thorac Surg, 2010,11(4):442–446

    Article  PubMed  Google Scholar 

  30. Böning A, Diegeler A, Hilker M, et al. Preoperative atrial fibrillation and outcome in patients undergoing on-pump or off-pump coronary bypass surgery: lessons learned from the GOPCABE trial. Interact Cardiovasc Thorac Surg, 2015,20(1):74–78

    Article  PubMed  Google Scholar 

  31. Bull DA, Neumayer LA, Stringham JC, et al. Coronary artery bypass grafting with cardiopulmonary bypass versus off-pump cardiopulmonary bypass grafting: does eliminating the pump reduce morbidity and cost? Ann Thorac Surg, 2001,71(1):170–175

    Article  PubMed  CAS  Google Scholar 

  32. Calafiore AM, Di Mauro M, Canosa C, et al. Early and late outcome of myocardial revascularization with and without cardiopulmonary bypass in high risk patients (EuroSCORE > or = 6). Eur J Cardiothorac Surg, 2003,23(3):360–367

    Article  PubMed  Google Scholar 

  33. Czerny M, Baumer H, Kilo J, et al. Inflammatory response and myocardial injury following coronary artery bypass grafting with or without cardiopulmonary bypass. Eur J Cardiothorac Surg, 2000,17(6):737–742

    Article  PubMed  CAS  Google Scholar 

  34. Czerny M, Baumer H, Kilo J, et al. Complete revascularization in coronary artery bypass grafting with and without cardiopulmonary bypass. Ann Thorac Surg, 2001,71(1):165–169

    Article  PubMed  CAS  Google Scholar 

  35. Gerola LR, Buffolo E, Jasbik W, et al. Off-pump versus on-pump myocardial revascularization in low-risk patients with one or two vessel disease: perioperative results in a multicenter randomized controlled trial. Ann Thorac Surg, 2004,77(2):569–573

    Article  PubMed  Google Scholar 

  36. Haase M, Sharma A, Fielitz A, et al. On-pump coronary artery surgery versus off-pump exclusive arterial coronary grafting: a matched cohort comparison. Ann Thorac Surg, 2003,75(1):62–67

    Article  PubMed  Google Scholar 

  37. Hravnak M, Hoffman LA, Saul MI, et al. Short-term complications and resource utilization in matched subjects after on-pump or off-pump primary isolated coronary artery bypass. Am J Crit Care, 2004,13(6):499–508

    PubMed  PubMed Central  Google Scholar 

  38. Johansson-Synnergren M, Nilsson F, Bengtsson A, et al. Off-pump CABG reduces complement activation but does not significantly affect peripheral endothelial function: a prospective randomized study. Scand Cardiovasc J, 2004,38(1):53–58

    Article  PubMed  Google Scholar 

  39. Karthik S, Musleh G, Grayson AD, et al. Coronary surgery in patients with peripheral vascular disease:effect of avoiding cardiopulmonary bypass. Ann Thorac Surg, 2004,77(4):1245–1249

    Article  PubMed  Google Scholar 

  40. Kim K-B, Kang CH, Chang W-I, et al. Off-pump coronary artery bypass with complete avoidance of aortic manipulation. Ann Thorac Surg, 2002,74(4):S1377–1382

    Article  PubMed  Google Scholar 

  41. Kobayashi J, Tashiro T, Ochi M, et al. Early outcome of a randomized comparison of off-pump and on-pump multiple arterial coronary revascularization. Circulation, 2005,112(9 Suppl):I338–I343

    PubMed  Google Scholar 

  42. Lee JD, Lee SJ, Tsushima WT, et al. Benefits of off-pump bypass on neurologic and clinical morbidity: a prospective randomized trial. Ann Thorac Surg, 2003,76(1):18–26

    Article  PubMed  Google Scholar 

  43. Légaré JF, Buth KJ, King S, et al. Coronary bypass surgery performed off pump does not result in lower in-hospital morbidity than coronary artery bypass grafting performed on pump. Circulation, 2004,109(7):887–892

    Article  PubMed  Google Scholar 

  44. Mack MJ, Pfister A, Bachand D, et al. Comparison of coronary bypass surgery with and without cardiopulmonary bypass in patients with multivessel disease. J Thorac Cardiovasc Surg, 2004,127(1):167–173

    Article  PubMed  Google Scholar 

  45. Mariscalco G, Engström KG, Ferrarese S, et al. Relationship between atrial histopathology and atrial fibrillation after coronary bypass surgery. J Thorac Cardiovasc Surg, 2006,131(6):1364–1372

    Article  PubMed  Google Scholar 

  46. Muneretto C, Bisleri G, Negri A, et al. Off-pump coronary artery bypass surgery technique for total arterial myocardial revascularization: a prospective randomized study. Ann Thorac Surg, 2003,76(3):778–783

    Article  PubMed  Google Scholar 

  47. Penttilä HJ, Lepojärvi MV, Kiviluoma KT, et al. Myocardial preservation during coronary surgery with and without cardiopulmonary bypass. Ann Thorac Surg, 2001,71(2):565–570

    Article  PubMed  Google Scholar 

  48. Puskas JD, Williams WH, Duke PG, et al. Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: a prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting. J Thorac Cardiovasc Surg, 2003,125(4):797–808

    Article  PubMed  CAS  Google Scholar 

  49. Saleh HZ, Shaw M, Fabri BM, et al. Does avoidance of cardiopulmonary bypass confer any benefits in octogenarians undergoing coronary surgery? Interact Cardiovasc Thorac Surg, 2011,12(2):435–439

    Article  PubMed  Google Scholar 

  50. Smith A, Grattan A, Harper M, et al. Coronary revascularization: A procedure in transition from on-pump to off-pump? The role of glucose-insulin-potassium revisited in a randomized, placebo-controlled study. J Cardiothorac Vasc Anesth, 2002,16(4):413–420

    Article  PubMed  Google Scholar 

  51. Straka Z, Widimsky P, Jirasek K, et al. Off-pump versus on-pump coronary surgery: final results from a prospective randomized study PRAGUE-4. Ann Thorac Surg, 2004,77(3):789–793

    Article  PubMed  Google Scholar 

  52. Tamis-Holland JE, Homel P, Durani M, et al. Atrial fibrillation after minimally invasive direct coronary artery bypass surgery. J Am Coll Cardiol, 2000,36(6):1884–1888

    Article  PubMed  CAS  Google Scholar 

  53. Tashnizi MA, Zirak N, Bakavoli AH, et al. Atrial fibrillation after off-pump versus on-pump coronary artery bypass graft surgery. Iran Heart J, 2012,12(4):48–53

    Google Scholar 

  54. Tran DT, Perry JJ, Dupuis JY, et al. Predicting new-onset postoperative atrial fibrillation in cardiac surgery patients. J Cardiothorac Vasc Anesth, 2015,29(5):1117–1126

    Article  PubMed  Google Scholar 

  55. van Dijk D, Nierich AP, Jansen EW, et al. Early outcome after off-pump versus on-pump coronary bypass surgery: results from a randomized study. Circulation, 2001,104(15):1761–1766

    Article  PubMed  Google Scholar 

  56. Wan IY, Arifi AA, Wan S, et al. Beating heart revascularization with or without cardiopulmonary bypass:evaluation of inflammatory response in a prospective randomized study. J Thorac Cardiovasc Surg, 2004,127(6):1624–1631

    Article  PubMed  Google Scholar 

  57. Widimsky P, Straka Z, Stros P, et al. One-year coronary bypass graft patency: a randomized comparison between off-pump and on-pump surgery angiographic results of the PRAGUE-4 trial. Circulation, 2004,110(22):3418–3423

    Article  PubMed  Google Scholar 

  58. Zamvar V, Williams D, Hall J, et al. Assessment of neurocognitive impairment after off-pump and on-pump techniques for coronary artery bypass graft surgery: prospective randomised controlled trial. BMJ, 2002,325(7375):1268

    Article  PubMed  PubMed Central  Google Scholar 

  59. Amar D, Zhang H, Leung DH, et al. Older age is the strongest predictor of postoperative atrial fibrillation. Anesthesiology, 2002,96(2):352–356

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

    Chuang-yan Wu  (吴创炎) & Jia-hong Xia  (夏家红)

  2. Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

    Si-hua Wang  (王思桦)

  3. Department of Cardiovascular Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China

    Yu-qiang Shang  (尚玉强)

Authors
  1. Chuang-yan Wu  (吴创炎)
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Si-hua Wang  (王思桦)
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yu-qiang Shang  (尚玉强)
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jia-hong Xia  (夏家红)
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Yu-qiang Shang  (尚玉强) or Jia-hong Xia  (夏家红).

Additional information

This project was supported by the National Natural Science Foundation of China (No. 81401323 and No. 81130056).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wu, Cy., Wang, Sh., Shang, Yq. et al. Incidence of atrial fibrillation after off-pump versus on-pump coronary artery bypass grafting: A meta-analysis of randomized clinical trials and propensity score matching trials. CURR MED SCI 37, 956–964 (2017). https://doi.org/10.1007/s11596-017-1834-5

Download citation

  • Received:

  • Revised:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11596-017-1834-5

Key words

Search

Navigation