Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting Academic Article uri icon

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abstract

  • BACKGROUND: We previously reported that there was no significant difference at 30 days or at 1 year in the rate of the composite outcome of death, stroke, myocardial infarction, or renal failure between patients who underwent coronary-artery bypass grafting (CABG) performed with a beating-heart technique (off-pump) and those who underwent CABG performed with cardiopulmonary bypass (on-pump). We now report the results at 5 years (the end of the trial). METHODS: A total of 4752 patients (from 19 countries) who had coronary artery disease were randomly assigned to undergo off-pump or on-pump CABG. For this report, we analyzed a composite outcome of death, stroke, myocardial infarction, renal failure, or repeat coronary revascularization (either CABG or percutaneous coronary intervention). The mean follow-up period was 4.8 years. RESULTS: There were no significant differences between the off-pump group and the on-pump group in the rate of the composite outcome (23.1% and 23.6%, respectively; hazard ratio with off-pump CABG, 0.98; 95% confidence interval [CI], 0.87 to 1.10; P=0.72) or in the rates of the components of the outcome, including repeat coronary revascularization, which was performed in 2.8% of the patients in the off-pump group and in 2.3% of the patients in the on-pump group (hazard ratio, 1.21; 95% CI, 0.85 to 1.73; P=0.29). The secondary outcome for the overall period of the trial - the mean cost in U.S. dollars per patient - also did not differ significantly between the off-pump group and the on-pump group ($15,107 and $14,992, respectively; between-group difference, $115; 95% CI, -$697 to $927). There were no significant between-group differences in quality-of-life measures. CONCLUSIONS: In our trial, the rate of the composite outcome of death, stroke, myocardial infarction, renal failure, or repeat revascularization at 5 years of follow-up was similar among patients who underwent off-pump CABG and those who underwent on-pump CABG. (Funded by the Canadian Institutes of Health Research; CORONARY ClinicalTrials.gov number, NCT00463294 .).

authors

  • Lamy, Andre
  • Devereaux, Philip
  • Prabhakaran, Dorairaj
  • Taggart, David P
  • Hu, Shengshou
  • Straka, Zbynek
  • Piegas, Leopoldo S
  • Avezum, Alvaro
  • Akar, Ahmet R
  • Lanas Zanetti, Fernando
  • Jain, Anil R
  • Noiseux, Nicolas
  • Padmanabhan, Chandrasekar
  • Bahamondes, Juan-Carlos
  • Novick, Richard J
  • Tao, Liang
  • Olavegogeascoechea, Pablo A
  • Airan, Balram
  • Sulling, Toomas-Andres
  • Whitlock, Richard
  • Ou, Yongning
  • Gao, Peggy
  • Pettit, Shirley
  • Yusuf, Salim

publication date

  • December 15, 2016

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