Principal Findings:

A total of 401 were evaluated. 200 eligible patients were randomized to on-pump (n=100) and off-pump surgery (n=100) for BHACAS 1 and 201 patients were randomized to on-pump (n=101) and off-pump surgery (n=100) for BHACAS 2. Baseline characteristics were comparable among groups. Pooling of data from both trials showed that risk of in-hospital morbidity (within 30 days of surgery) was lower in patients who had off-pump than in those who had on-pump surgery for transfusion of packed blood cells (-31%, 95% CI -41 to -21) and fresh frozen plasma (-15%, 95% CI -21 to -9), intubation time longer than 10 h (-16%, 95% CI -25 to -6), intensive-care unit stay for longer than 1 day (-13%, 95% CI -25 to -6), and total hospital stay longer than 7 days(-13%, 95% CI -21 to -5). Pooled survival estimates at 24 months were 96% (95% CI 91–98) and 97% (92–99) for on-pump and off-pump groups, respectively. No cardiac event differed in frequency between groups. Myocardial infarction was diagnosed in 4% of patients in the on-pump groups and in four 2% in the off-pump groups. Recurrent angina was recorded in 14% of patients in the on-pump groups and in 12% of patients in the off-pump groups. The hazard ratio for all cause mortality or cardiac related events was 0.78 (95% CI 0.49–1.22) for off-pump compared with on-pump surgery for both trials combined. Pooled estimates for survival free from any cardiac-related event at 24 months were 78% (71–84) and 84% (78–89) for on-pump and off-pump groups. After pooling data for BHACAS 1 and 2, no significant differences were recorded in the pooled frequencies of any non cardiac-related events between on-pump and off-pump groups.