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Published on: March 27, 2018
Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting
André Lamy1, P J Devereaux1, Dorairaj Prabhakaran1
1From the Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON (A.L., P.J.D., R.P.W., Y.O., P.G., S.P., S.Y.), Centre Hospitalier de l'Université de Montréal, Montreal (N.N.), and the University of Calgary, Calgary, AB (R.J.N.) - all in Canada; the Center for Chronic Disease Control, Gurgaon (D.P.), SAL Hospital, Ahmedabad (A.R.J.), G. Kuppuswamy Naidu Memorial Hospital, Coimbatore (C.P.), and All India Institute of Medical Sciences, New Delhi (B.A.) - all in India; the University of Oxford, Oxford, United Kingdom (D.P.T.); Fu Wai Cardiovascular Hospital, Xicheng District, Beijing (S.H.), and Wuhan Asia Heart Hospital, Wuhan (L.T.) - both in China; Third Faculty of Medicine Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic (Z.S.); Instituto Dante Pazzanese de Cardiologia, São Paulo (L.S.P., A.A.); Ankara University School of Medicine, Ankara, Turkey (A.R.A.); Hospital Regional de Temuco and Universidad de la Frontera, Temuco, Chile (F.L.Z., J.-C.B.); Fundación Médica de Río Negro y Neuquén, Rio Negro, Argentina (P.A.O.); and North Estonia Medical Center, Tallinn, Estonia (T.-A.S.).
Insights
Five-year results show no significant difference in major adverse events between off-pump and on-pump coronary artery bypass grafting (CABG). Both surgical techniques for coronary artery disease offer similar long-term outcomes and costs.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Clinical Trials
Background:
- Previous reports indicated no significant differences at 30 days or 1 year between off-pump and on-pump coronary artery bypass grafting (CABG).
- This study presents the 5-year follow-up results of the CORONARY trial, evaluating long-term outcomes.
Purpose of the Study:
- To compare the long-term efficacy and safety of off-pump versus on-pump CABG.
- To assess the composite outcome of death, stroke, myocardial infarction, renal failure, or repeat revascularization at 5 years.
Main Methods:
- A total of 4752 patients with coronary artery disease were randomized to either off-pump or on-pump CABG across 19 countries.
- The primary composite outcome included death, stroke, myocardial infarction, renal failure, or repeat coronary revascularization.
- Mean follow-up was 4.8 years, with analysis of secondary outcomes including costs and quality of life.
Main Results:
- The 5-year composite outcome rate was similar between groups: 23.1% for off-pump CABG versus 23.6% for on-pump CABG (HR, 0.98; 95% CI, 0.87-1.10).
- Rates of repeat coronary revascularization were also comparable (2.8% off-pump vs. 2.3% on-pump; HR, 1.21; 95% CI, 0.85-1.73).
- No significant differences were observed in mean patient costs or quality-of-life measures between the two surgical approaches.
Conclusions:
- Off-pump CABG and on-pump CABG demonstrate similar rates of major adverse cardiovascular events at 5 years.
- The findings support the long-term safety and effectiveness of both off-pump and on-pump CABG techniques for patients with coronary artery disease.
- No significant differences in costs or quality of life were found between the surgical methods.
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 .).
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