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  

作　　者：吴创炎 王思桦 尚玉强 夏家红 

机构地区：[1]Department of Cardiovascular Surgery,Wuhan 430022,China [2]Department of Thoracic Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China [3]Department of Cardiovaseular Surgery,The Central Hospital of Wuhan,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430014,China

出　　处：《Journal of Huazhong University of Science and Technology(Medical Sciences)》2017年第6期956-964,共9页华中科技大学学报（医学英德文版）

基　　金：supported by the National Natural Science Foundation of China(No.81401323 and No.81130056)

摘　　要：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 Pub Med, Embase, Web of Science, and Cochrane to identify the association of post-CABG AF with on-pump（conventional CABG, c CABG） 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 c CABG 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 c CABG and that younger patients may benefit more from OPCAB and have a lower incidence of post-CABG AF.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 Pub Med, Embase, Web of Science, and Cochrane to identify the association of post-CABG AF with on-pump（conventional CABG, c CABG） 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 c CABG 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 c CABG and that younger patients may benefit more from OPCAB and have a lower incidence of post-CABG AF.

关 键 词：off-pump coronary artery bypass coronary artery bypass surgery atrial fibrillation 

分 类 号：R654.2[医药卫生—外科学]