Objective：To evaluate the effect of atrial fibrillation，stroke and case fatality rate in elderly patients（age ≥80 years）undergoing on-pump coronary artery bypass surgery（CCAB）or off-pump coronary artery bypass surgery（OPCAB）. Methods：We searched relevant literature in MEDLINE，EMBASE，Cochrane Library. Meanwhile，conference records or gray literature from cardiovascular congresses were collected to compare CCAB and OPCAB for elderly patients. Meta analysis was performed using Review Manager 5.3 software. Results：A total of 15 articles were included in the meta-analysis，all of which were observed，and randomized controlled studies（RCT）were not retrieved. A total of 3 271 patients were enrolled in this meta-analysis，of which 1 573（48%）were CCAB. Meta-analysis showed that the OPCAB significantly reduced the incidence of postoperative patients with stroke（OR = 2.77，95% CI：1.65~1.65，P < 0.001）and case fatality rate（OR = 2.08，95% CI：1.52~1.52，P < 0.001），and the differences were statistically significant（P < 0.05）. Two groups of patients with had no significant difference on postoperative incidence of atrial fibrillation（OR = 1.01，95% CI：0.84~0.84，P=0.91）. Conclusion：Compared with CCAB，OPCAB can significantly reduce the incidence of postoperative stroke and case fatality rate in elderly patients，but big size randomized controlled trials are needed for further verification.