Ann Thorac Surg 2008;86:690. doi:10.1016/j.athoracsur.2008.02.049
© 2008 The Society of Thoracic Surgeons
Correspondence
Neurocognitive Decline After Off-Pump Versus On-Pump Coronary Artery Bypass
Hisato Takagi, MD, PhD,
Norikazu Kawai, MD,
Takuya Umemoto, MD, PhD
Department of Cardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka 411-8611, Japan
(Email: kfgth973{at}ybb.ne.jp).
To the Editor:
The recent randomized controlled trial (RCT) by Hernandez and associates [1] demonstrated no statistically significant difference in neurocognitive decline at discharge or at 6 months between conventional coronary artery bypass (CCAB) and off-pump coronary artery bypass (OPCAB) procedures. On the other hand, we previously performed a meta-analysis of RCTs of OPCAB versus CCAB and found better neurocognitive outcomes at 1 to 3 months, but negligible effects within 2 weeks and 6 to 12 months after the procedure in OPCAB than in CCAB surgery [2]. Because our meta-analysis [2] did not include the RCT by Hernandez and colleagues [1], we herein performed an updated meta-analysis of currently available RCTs regarding neurocognitive decline after OPCAB versus CCAB.
Our comprehensive search identified 9 RCTs (10 articles) [1, 3–11] reporting the incidence of neurocognitive decline at any point. In total, our meta-analysis included data on 1,012 patients. Pooled analysis of the six trials [1, 4, 6–8, 11] reporting the within-2-week incidence of cognitive decline demonstrated a statistically nonsignificant benefit of OPCAB in comparison with CCAB surgery for cognitive decline in a random effects model (OPCAB, 42.4%; CPCAB, 57.4%; risk ratio [RR], 0.78; 95% confidence interval [CI], 0.58 to 1.06; p = 0.11). There was significant between study heterogeneity of results analyzed by means of standard 
2 tests (p = 0.03). When data from the six trials [3, 5, 6, 9–11] reporting the 1-month to 3-month incidence of cognitive decline were pooled, OPCAB surgery was associated with a statistically significant reduction in cognitive decline relative to CCAB surgery (OPCAB, 21.0%; CPCAB, 30.4%; RR, 0.75; 95% CI, 0.57 to 0.99; p = 0.04). There was no between study heterogeneity of results (p = 0.32). Pooled analysis of the five trials [1, 5, 7, 9, 11] reporting the 6-month to 12-month incidence of cognitive decline demonstrated a statistically nonsignificant benefit of OPCAB in comparison with CCAB surgery for cognitive decline (OPCAB, 31.3%; CPCAB, 33.2%; RR, 0.95; 95% CI, 0.77 to 1.17; p = 0.62). There was no between study heterogeneity of results (p = 0.99). In all of the previously mentioned three meta-analyses, there was no evidence of significant publication bias assessed using an adjusted rank correlation test (p = 0.57; p = 0.19; p = 0.33).
The present meta-analysis of currently available RCTs supports the results of the RCT by Hernandez and associates [1].
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References
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