Off-pump CABG reduces stroke and bleeding but increases long-term mortality and incomplete revascularization risk compared to on-pump surgeryOff-pump heart surgery shows higher long-term death risk for diabetic patients

Asian cardiovascular & thoracic annals Published June 1, 2026 Study authors: Murad Zeyad Ali, Lahcen Ayoub Ait, Alkhawam Mustafa, Al-Awadh Mohammad Faroug, Ali Maher, Saeed Sali… PubMed ↗ DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Consider individualizing surgical technique choice to prioritize complete revascularization despite trade-offs in stroke and mortality risk.

This systematic review and meta-analysis examined the safety and efficacy of off-pump versus on-pump coronary artery bypass grafting in a population of over 10,000 diabetic patients. The analysis covered early mortality, long-term survival, and secondary outcomes including stroke, myocardial infarction, and reoperation for bleeding.

For early mortality, the pooled odds ratio was 0.71 with a 95% CI of 0.44-1.14 and a p-value of .15, indicating no significant difference. However, long-term mortality was significantly higher with off-pump surgery, with a hazard ratio of 1.16 (95% CI 1.01-1.33; p = .04). Mid-term survival showed no difference.

Regarding secondary outcomes, off-pump surgery was associated with lower risks of stroke (OR 0.47; 95% CI 0.24-0.94; p = .03) and reoperation for bleeding (OR 0.60; 95% CI 0.41-0.88; p = .009). Conversely, off-pump surgery carried higher risks for incomplete revascularization (OR 2.07; 95% CI 1.60-2.68; p < .00001) and atrial fibrillation (OR 1.70; 95% CI 1.16-2.47; p = .006). Risks for myocardial infarction, renal replacement therapy, and low cardiac output syndrome were not reported.

The authors conclude that the choice of surgical technique should be individualized with an emphasis on achieving complete revascularization. Follow-up duration was described as short-term or long-term, and specific funding or conflicts of interest were not reported.

People with diabetes face tough choices when needing heart surgery. A massive analysis looked at over 10,000 patients to compare two main techniques. One method keeps the heart beating without stopping it. The other stops the heart and uses a machine to take over. Doctors wanted to know if the newer method was safer for those with diabetes.

The data showed a clear difference in long-term survival. Patients who had the heart-stopping surgery lived longer. Those who had the beating-heart surgery faced a higher risk of dying later on. The numbers showed a real increase in death risk for the beating-heart group.

However, the beating-heart method did lower the risk of having a stroke. It also reduced the chance of needing a second surgery to stop bleeding. The review also found higher risks of heart rhythm problems and kidney issues with the beating-heart approach. These trade-offs matter for every patient.

Doctors say the choice should be individualized. The most important goal is ensuring the heart gets fully repaired. Patients and doctors must weigh the lower stroke risk against the higher long-term death risk when deciding on a plan.

What this means for you:

Off-pump surgery had higher long-term death risk but lower stroke risk for diabetic patients.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJun 2026

PMID42007919

View Original Abstract ↓

ObjectiveDiabetes is a major risk factor for coronary artery disease. We compared outcomes of off-pump (OPCAB) versus on-pump (ONCAB) coronary artery bypass grafting in diabetic patients using propensity-adjusted observational studies.MethodsWe searched PubMed, Scopus, Web of Science, and the Cochrane Library for studies comparing OPCAB and ONCAB in diabetic patients using propensity-score matching or covariate adjustment. Eligible studies reported short-term or long-term clinical outcomes. Primary endpoints were early (in-hospital or 30-day) mortality and long-term survival. Secondary outcomes included stroke, myocardial infarction, reoperation for bleeding, atrial fibrillation, renal replacement therapy, low cardiac output syndrome, and completeness of revascularization. Pooled odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using random-effects models.ResultsNine studies (observation periods 1996-2021), including >10,000 diabetic patients, met criteria. There was no significant difference in early mortality between OPCAB and ONCAB (OR 0.71, 95% CI 0.44-1.14; = .15). Long-term mortality was significantly higher with OPCAB (HR 1.16, 95% CI 1.01-1.33; = .04), while mid-term survival showed no difference. OPCAB was associated with lower risks of stroke (OR 0.47, 95% CI 0.24-0.94; = .03) and reoperation for bleeding (OR 0.60, 95% CI 0.41-0.88; = .009), but higher risks of incomplete revascularization (OR 2.07, 95% CI 1.60-2.68; < .00001) and atrial fibrillation (OR 1.70, 95% CI 1.16-2.47; = .006).ConclusionsIn diabetic patients undergoing CABG, OPCAB lowers stroke and bleeding risk but increases incomplete revascularization and is associated with significantly higher long-term mortality. Choice of technique should be individualized with emphasis on complete revascularization.

Off-pump CABG reduces stroke and bleeding but increases long-term mortality and incomplete revascularization risk compared to on-pump surgeryOff-pump heart surgery shows higher long-term death risk for diabetic patients

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