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Long-term survival is lower in off pump versus on pump CABG patients reports a study of 5203 patients published in JACC.

Thursday, April 24, 2014

Submitted by

Joel Dunning

Source

Source Name: Journal of the American college of Cardiology

Source URL: http://content.onlinejacc.org/article.aspx?articleID=1859515

Author(s)

Joon Bum Kim, MD, PhD1; Sung-Cheol Yun, PhD2; Jae Wong Lim, MD1; Soo Kyung Hwang, MD1; Sung-Ho Jung, MD1; Hyun Song, MD, PhD3; Cheol Hyun Chung, MD, PhD1; Jae Won Lee, MD, PhD1; Suk Jung Choo, MD, PhD1

Long-term survival following coronary artery bypass grafting: off-pump versus on-pump strategies
JACC - Journal of the American College of Cardiology, 04/18/2014 Evidence Based Medicine Clinical Article

Although several large–scale clinical trials have compared the surgical outcomes between off–pump and on–pump CABG, the long–term survival has not been compared between the two surgical strategies in a reasonably sized cohort. To compare long–term survival after off–pump and on–pump coronary artery bypass grafting (CABG). In patients undergoing elective isolated CABG, on–pump strategy conferred a long–term survival advantage compared with off–pump strategy.

Methods

Authors evaluated long–term survival data in 5203 patients (aged 62.9±9.1 years, 1340 females) who underwent elective isolated CABG (off–pump, n=2333; on–pump, n=2870) from 1989 through 2012.
Vital statuses were validated from Korean National Registry of Vital Statistics.
Long–term survival was compared with the use of propensity scores and inverse–probability–weighting to adjust selection bias.

Results

Patients undergoing on–pump CABG had higher number of distal anastomoses than those undergoing off–pump CABG (3.7±1.2 vs. 3.0±1.1, P<0.001).
Survival data were complete in 5167 patients (99.3%) with a median follow–up duration of 6.4 years (inter–quartile range, 3.7–10.5 years; maximum 23.1 years).
During follow–up, 1181 patients (22.7%) died.
After adjustment, both groups of patients showed a similar risk of death at 30–day (odds ratio, 0.70; 95% CI, 0.35–1.40; P=0.31) and up to one year (HR, 1.11; 95% CI, 0.74–1.65; P=0.62).
For overall mortality, however, patients undergoing off–pump CABG were at a significantly higher risk of death (HR, 1.43; 95% CI 1.19–1.71; P<0.0001) compared with those undergoing on–pump CABG.
In subgroup analyses, on–pump CABG conferred survival benefits in most demographic, clinical and anatomic subgroups compared with off–pump CABG