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Updated: Jun 1, 2026
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Graft patency and late outcomes for patients with ST-segment elevation myocardial infarction who underwent coronary
K Fattouch1, G Runza, M Moscarelli
1Department of Cardiac Surgery, University of Palermo, Palermo, Italy. khalilfattouch@hotmail.com
Insights
Urgent or emergency coronary artery bypass grafting (CABG) for ST-segment elevation myocardial infarction (STEMI) shows similar long-term outcomes and graft patency whether performed on-pump or off-pump. Both methods provide comparable survival and event-free rates.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Surgery Outcomes
Background:
- ST-segment elevation myocardial infarction (STEMI) often requires urgent revascularization.
- Coronary artery bypass grafting (CABG) is a critical treatment option for STEMI patients.
- The choice between on-pump and off-pump CABG for STEMI remains a subject of clinical debate regarding long-term efficacy.
Purpose of the Study:
- To evaluate the long-term clinical outcomes of patients with STEMI undergoing urgent or emergency CABG.
- To compare graft patency rates between on-pump and off-pump CABG in STEMI patients.
- To assess major adverse cardiac-related event (MACE) rates in relation to surgical approach.
Main Methods:
- A prospective follow-up study of 207 STEMI patients who underwent either on-pump (145) or off-pump (62) CABG.
- Graft patency assessed using 64-slice multi-detector computed tomography angiography.
- Comprehensive assessment of late mortality, graft patency, and MACE rates with 100% follow-up completion.
Main Results:
- No significant difference in late mortality rates between on-pump (7.4%) and off-pump (6.5%) groups (p=0.45).
- Five-year survival rates were comparable: 92.6% (on-pump) vs 93.5% (off-pump).
- Overall graft patency was high and similar in both groups (91.5% overall; 90.7% on-pump vs 91% off-pump).
Conclusions:
- Off-pump CABG demonstrates equivalent long-term mortality, MACE rates, and graft patency compared to conventional on-pump CABG in STEMI patients.
- Urgent or emergency CABG for STEMI can be performed effectively using either on-pump or off-pump techniques.
- The choice of surgical approach does not appear to compromise long-term clinical outcomes or graft viability.
Objective:
The aim of our study was to assess the long-term clinical outcomes and the grafts patency rates of patients with ST-segment elevation myocardial infarction (STEMI) who underwent urgent or emergency coronary artery bypass grafting (CABG).
Materials:
Participants in two previous studies comprising 207 STEMI patients undergoing on-pump (145 patients) or off-pump (62 patients) coronary artery bypass graft (CABG) surgery in our institution were prospectively followed to assess late mortality, graft patency, and major adverse cardiac-related event (MACE) rates. Graft patency was evaluated by multi-detector computed tomography angiography 64-slice scan. Mean times of graft implantation were 38±16 months and 37±14 months in on-pump and off-pump, respectively. Follow-up data were obtained in all patients and was 100% complete.
Results:
Late mortality rate was 7.4% (10 patients) in the on-pump and 6.5% (4 patients) in off-pump groups (p=0.45). Five-year overall survival rate (±SE) was 93.5±2.1% and 92.6±1.9% in the off-pump vs on-pump, respectively. Five years' freedom from cardiac-related death was 94.9±2.9% in the on-pump group vs 96.8±3.2% in the off-pump group (p=0.25). Five years' freedom from cardiac-related events was 89.7±1.6% in the on-pump group versus 93.5±1.8% in the off-pump group (p=0.32). In all patients, a total of 449/491 (91.5%) grafts were patent. Percentages of overall grafts classified as patent were similar in the on-pump group (90.7% - 322/355 conduits) versus the off-pump group (91% - 133/146 conduits). Graft patency rates were also similar between the two groups with regard to arterial and saphenous vein conduits, and with regard to different branches of the coronary arteries grafted.
Conclusion:
Our data suggest that off-pump CABG patients have the same late mortality, MACEs, and graft patency rates as conventional cardioplegic cardiac arrest CABG patients. In our opinion, urgent or emergency CABG for patients with STEMI can be done either way.
