Off-pump Versus On-pump Coronary Artery Bypass Grafting in Diabetic patients: A Meta-analysis of Observational Studies with a Propensity-Score Analysis

Abstract Purpose The debate between off-pump coronary artery bypass grafting (OPCAB) and on-pump coronary artery bypass grafting (ONCAB) in diabetic patients remains. This meta-analysis aimed to investigate outcomes after OPCAB versus ONCAB for patients with diabetes. Methods Literature research was conducted up to December 2023 using Ovid Medline, EMBASE, and the Cochrane Library. Eligible studies were observational studies with a propensity-score analysis of OPCAB versus ONCAB. The primary outcomes were early mortality and mid-term survival. The secondary outcomes were cerebrovascular accidents, reoperation for bleeding, incomplete revascularization, myocardial infarction, low cardiac output, and renal replacement therapy. Results Our research identified seven observational studies with a propensity-score analysis enrolling 13,085 patients. There was no significant difference between OPCAB and ONCAB for early mortality, mid-term survival, myocardial infarction, low cardiac output, and renal replacement therapy. OPCAB was associated with a lower risk of cerebrovascular accidents (OR 0.43; 95% CI, 0.24–0.76, P = 0.004) and reoperation for bleeding (OR 0.60; 95% CI, 0.41–0.88, P = 0.009). However, OPCAB was associated with a higher risk of incomplete revascularization (OR 2.07; 95% CI, 1.60–2.68, P < 0.00001). Conclusion Among patients with diabetes, no difference in early mortality and mid-term survival was observed. However, OPCAB was associated with a lower incidence of morbidity, including cerebrovascular accidents and reoperation for bleeding.