Spanuchart, Ittikorn

Abstract Aim The objective of this meta‐analysis was to compare the effects of off‐pump and on‐pump coronary artery bypass grafting ( CABG ) on acute kidney injury ( AKI ) and the need of dialysis after surgery. Methods Comprehensive literature searches for randomized controlled trials ( RCTs ) of CABG with on‐pump and off‐pump was performed using MEDLINE , EMBASE , C ochrane D atabase of S ystematic R eviews, C ochrane C entral R egister of C ontrolled T rials S ystematic R eviews and clinicaltrials.gov from inception through S eptember 2014. Primary outcomes were the incidence of AKI and the need of dialysis. Mortality was assessed among the studies that reported renal outcomes. Pooled risk ratios ( RR s) and 95% confidence interval ( CI ) were calculated using a random‐effect, generic inverse variance method. Results Thirty‐three RCTs with 17 322 patients were enrolled in our study. Patients in the off‐pump CABG group had overall lower incidence of AKI (19.1%) compared with the on‐pump CABG group (22.2%). There was a protective effect of off‐pump CABG on the incidence of AKI compared with the on‐pump CABG group ( RR : 0.87; 95% CI : 0.77–0.98). However, there was no significant difference in the need for dialysis in the off‐pump group compared with the on‐pump group ( RR : 0.84; 95% CI 0.63–1.13). Within the selected trials, post hoc analysis assessing the mortality outcome demonstrated a pooled RR of 0.97 (95% CI , 0.77–1.23) in off‐pump versus on‐pump CABGs . Conclusions Our study demonstrates a beneficial effect of off‐pump CABG on the incidence of AKI . However, our meta‐analysis does not show benefits of the need of dialysis or survival among patients undergoing off‐pump CABG .

AimTo investigate the association between primary biliary cirrhosis (PBC) and risk of coronary artery disease (CAD).MethodsWe conducted a systematic review and meta‐analysis of published observational studies that reported relative risks, odd ratios, hazard ratios or standardized incidence ratios with 95% confidence intervals (CI) comparing CAD risk in patients with PBC versus non‐PBC controls. Pooled risk ratios and 95% confidence intervals were combined using a random‐effect model and generic inverse variance of DerSimonian and Laird methods.ResultFour studies with 3362 patients with PBC were identified and included in our data analysis. The pooled risk ratio of CAD in patients with PBC was 1.57 (95% CI, 1.21–2.06). The statistical heterogeneity was low with an I2 of 38%.ConclusionOur study demonstrated a statistically significant increased risk of CAD among patients with PBC.