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Long-term survival after off-pump coronary artery bypass surgery: a Swedish nationwide cohort study

Magnus Dalén1, Torbjörn Ivert, Martin J Holzmann

  • 1Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.

The Annals of Thoracic Surgery
|October 1, 2013
PubMed

Insights

Long-term survival was similar for patients undergoing off-pump versus on-pump coronary artery bypass grafting (CABG). This nationwide study found no significant survival benefit for either surgical approach in isolated, non-emergent cases.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Outcomes Research

Background:

  • Coronary artery bypass grafting (CABG) is a common surgical procedure for coronary artery disease.
  • Off-pump CABG (OPCAB) has been proposed as an alternative to traditional on-pump CABG, potentially reducing complications.
  • Evidence comparing long-term survival between OPCAB and on-pump CABG in large, nationwide cohorts is limited.

Purpose of the Study:

  • To compare long-term survival rates between primary isolated off-pump CABG and on-pump CABG.
  • To evaluate the association of OPCAB with early mortality and a composite of death or rehospitalization for major cardiovascular events.
  • To analyze trends in the utilization of OPCAB over time.

Main Methods:

  • Analysis of a nationwide cohort of patients undergoing primary isolated nonemergent CABG in Sweden (1998-2008).
  • Utilized Swedish national registers for patient data and outcome ascertainment.
  • Employed multivariable regression and propensity score-matched analyses to compare outcomes between OPCAB and on-pump CABG.

Main Results:

  • Included 50,676 patients; 6.6% underwent OPCAB.
  • No significant difference in long-term survival between OPCAB and on-pump CABG in adjusted analyses (HR 0.99; 95% CI: 0.92-1.06) or propensity-matched cohort (HR 1.02; 95% CI: 0.91-1.16).
  • Similar findings for early mortality and the composite endpoint.

Conclusions:

  • Long-term survival is comparable between off-pump and on-pump CABG for non-emergent primary isolated procedures.
  • Off-pump CABG utilization was infrequent and declined during the study period.
  • These findings suggest no survival advantage for OPCAB in this specific patient population.
Abstract

Keywords:
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