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Does off-pump coronary artery bypass reduce the incidence of post-operative atrial fibrillation? A question revisited.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Athanasiou, Thanos Aziz, Omer Mangoush, Omar Al-Ruzzeh, Sharif Nair, Suresh Malinovski, Vitali Casula, Roberto P. Glenville, Brian E. |
| Copyright Year | 2004 |
| Abstract | Atrial fibrillation (AF) is the most common post-operative complication in patients undergoing coronary artery bypass grafting, with an increased incidence associated with advancing age. This study aims to determine whether off-pump coronary artery bypass (OPCAB) reduces the incidence of AF in a generalized population (mean age <70 years). A meta-analysis was performed including all randomised and propensity score matched non-randomised studies published between 2001 and 2003 reporting a comparison between the two techniques in a generalised patient group (average age <70 years). The primary outcome of interest was post-operative AF. Sensitivity analysis was performed to evaluate consistency of the calculated treatment effect. Fourteen studies fulfilled our inclusion criteria, including a total of 16,505 subjects. The incidence of AF was 19% (1612/8265) in the off-pump group versus 24% (1976/8240) in the on-pump group. When considering only the 11 randomised studies (2207 subjects), we found a significant reduction in the incidence of post-operative AF in the off-pump group using a random-effect model (odds ratio (OR)=0.60, 95% confidence interval (CI)=0.45-0.82, and chi-square of heterogeneity=18.02, P=0.05). Sensitivity analysis highlighted one randomised study causing funnel plot asymmetry, exclusion of which resulted in a significant reduction in the incidence of post-operative AF in the off-pump group (OR=0.71, 95% CI=0.57-0.90), with a non-significant heterogeneity of 3.91 (P=0.92). When only studies of high quality were considered (898 patients), no significant difference was seen between on and off-pump groups (OR=0.78, 95% CI=0.57-1.07, and heterogeneity=0.53, P=0.91). This may be due to small number of patients in this group. Our results suggest that although OPCAB surgery may reduce the incidence of post-operative AF in a generalised population (age <70 years) this finding is not clearly supported by high quality randomised trials. Although previous evidence suggests that the incidence of post-operative AF is reduced in an elderly population (>70 years) with off-pump surgery, our results show that the evidence is less clear in a younger population group. The question of whether off-pump surgery in this patient group results in a lower rate of post-operative AF remains to be answered by further high quality randomised research. |
| Starting Page | 63 |
| Ending Page | 71 |
| Page Count | 9 |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/ejcts/26/4/10.1016/j.ejcts.2004.05.053/2/26-4-701.pdf?Expires=1491849108&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q&Signature=R9xhvUjVrPlDRrsT-iiod73CP9dFoS2qUfG0lXQpZZpr4jQLgJ8wqjFXVDnkRQjavgTO704bnspWho0rdAk1h1pqOaesOu6c9ahT4Xws-~5VwRAwqUPT9hbp0qVAZZMwmH6NdUD79UnI6Ys3uPT82ffAbT4ES3fLF49voHCJDmm0CcL5r4OlPZjWROInlyXNReD7tn2D1EIi7ckZarPbZNxKIsZ-hJVPXI23OErdSYuq1wGQIDZEsom1YFb0E9V3QMTb8yGE6ntySrWdRcM2j5Hnjuw3C6Z8MBh421oVfe0eVWrGycEl~gJjG8Jpmf4ZhQmRB1RdjlG6qTI8ltHuHw__ |
| PubMed reference number | 15450560v1 |
| Volume Number | 26 |
| Issue Number | 4 |
| Journal | European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery |
| Language | English |
| Access Restriction | Open |
| Subject Keyword | Atrial Fibrillation Confidence Intervals Coronary Artery Bypass Surgery Coronary Artery Bypass, Off-Pump Exclusion Heart Atrium Patients Propensity Score Scientific Publication Ventricular Fibrillation |
| Content Type | Text |
| Resource Type | Article |
