OBJECTIVES: The aim of this analysis was to compare survival outcomes of coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) with those of conventional CABG. METHODS: Eight observational studies were included in this analysis, including 10 529 different patients in Asia, Europe and North America, from 1985 to 2012, among whom 1925 underwent CE + CAGB and 8604 underwent conventional CAGB. The follow-up period ranged from 4 to 14 years. This meta-analysis was performed with the fixed-effects model. RESULTS: After rigorous assessment of the quality of the studies included, this analysis showed that CE + CABG had a statistically significant weaker short-term outcome, with a higher risk of mortality [odds ratio (OR)] 1.61; P = 0.002]. Further, this phenomenon was exacerbated in the midterm. One-year and 2-year results indicated that death was, respectively, 163% (OR 2.63; P < 0.001) and 133% (OR 2.60; P < 0.001) more likely to occur in the CE + CABG group. However, the long-term results indicated no difference between the 2 groups. The 4-year hazard ratio (1.13; P = 0.10) did not show significant differences between the groups, and the Kaplan-Meier survival curves had the same level and pattern. CONCLUSIONS: CE + CABG had a significantly weaker short-term outcome than conventional CABG, and this trend continued in the midterm. The survival rate had the largest gap in the midterm. However, there was no significant difference between these 2 groups in the long run. © The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.