Risk-adjusted analysis of long-term outcomes after on- versus off-pump coronary artery bypass grafting. (1st August 2021)

• Record Type: Journal Article
• Authors: Deutsch, Marcus-André; Zittermann, Armin; Renner, André; Schramm, René; Götte, Julia; Börgermann, Jochen; Fox, Henrik; Rojas, Sebastian V; Gyoten, Takayuki; Morshuis, Michiel; Koster, Andreas; Hulde, Nikolai; Hinse, Dennis; Hakim-Meibodi, Kavous; Gummert, Jan F
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 33:Number 6(2021)
• Page Start: 857
• Page End: 865
• Publication Date: 2021-08-01
• Subjects: Coronary artery disease -- Coronary artery bypass grafting -- Myocardial revascularization -- Off-pump coronary artery bypass grafting -- Off-pump surgery; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivab179
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: : OBJECTIVES: Recent data suggested that off-pump coronary artery bypass (OPCAB) may carry a higher risk for mortality in the long term when compared to on-pump coronary artery bypass (ONCAB). We, therefore, compared long-term survival and morbidity in patients undergoing ONCAB versus OPCAB in a large single-centre cohort. METHODS: A total of 8981 patients undergoing isolated elective/urgent coronary artery bypass grafting between January 2009 and December 2019 were analysed. Patients were stratified into 2 groups (OPCAB n = 6649/ONCAB n = 2332). The primary end point was all-cause mortality. Secondary endpoints included repeat revascularization, stroke and myocardial infarction. To adjust for potential selection bias, 1:1 nearest neighbour propensity score (PS) matching was performed resulting in 1857 matched pairs. Moreover, sensitivity analysis was applied in the entire study cohort using multivariable- and PS-adjusted Cox regression analysis. RESULTS: In the PS-matched cohort, 10-year mortality was similar between study groups [OPCAB 36.4% vs ONCAB 35.8%: hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.87–1.12; P = 0.84]. While 10-year outcomes of secondary endpoints did not differ significantly, risk of stroke (OPCAB 1.50% vs ONCAB 2.8%: HR 0.51, 95% CI 0.32–0.83; P = 0.006) and mortality (OPCAB 3.1% vs ONCAB 4.8%: HR 0.65, 95% CI 0.47–0.91; P = 0.011) at 1 year was lower in the OPCAB group. In the multivariable- and the PS-adjusted model, mortality at 10 years was not significantly different (OPCAB 34.1% vs ONCAB 35.7%: HR 0.97, 95% CI 0.87–1.08; P = 0.59 and HR 1.01, 95% CI 0.90–1.13; P = 0.91, respectively). CONCLUSIONS: Data do not provide evidence that elective/urgent OPCAB is associated with significantly higher risks of mortality, repeat revascularization, or myocardial infarction during late follow-up when compared to ONCAB. Patients undergoing OPCAB may benefit from reduced risks of stroke and mortality within the first year postoperatively. Abstract : By avoiding potentially deleterious adverse effects associated with the use of extracorporeal circulation and aortic cross clamping, the introduction of off-pump coronary artery bypass (OPCAB) has been thought to overcome some of the limitations of conventional on-pump coronary artery bypass (ONCAB).