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Published on: March 27, 2018
Five-Year Outcomes after On-Pump and Off-Pump Coronary-Artery Bypass
A Laurie Shroyer1, Brack Hattler1, Todd H Wagner1
1From Northport Veterans Affairs (VA) Medical Center, Northport, NY (A.L.S., M.B.); Eastern Colorado Health Care System, Department of Veterans Affairs (A.L.S., B.H., J.H.B., J.C.C., F.L.G.), and National Jewish Health (E.K.), Denver; the University of Colorado School of Medicine, Aurora (B.H., J.C.C., F.L.G.); VA Health Economics Resource Center and the Department of Surgery, Stanford University, Palo Alto, CA (T.H.W.); Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, MD (J.F.C.); VA Boston Healthcare System, West Roxbury, MA (J.A.Q.); Zablocki VA Medical Center and the Medical College of Wisconsin, Milwaukee (G.H.A.); Cleveland Clinic, Cleveland (F.B.); VA Pittsburgh Health Care System, Pittsburgh (F.B.); and Duke University Medical Center, Durham, NC (M.B.).
Insights
Off-pump coronary-artery bypass grafting (CABG) showed lower 5-year survival rates compared to on-pump CABG. This randomized trial suggests on-pump CABG may offer better long-term outcomes for patients.
Area of Science:
- Cardiovascular Surgery
- Clinical Trials
- Surgical Outcomes
Background:
- Coronary-artery bypass grafting (CABG) can be performed on-pump or off-pump.
- The Veterans Affairs trial compared clinical outcomes of these two CABG approaches.
Purpose of the Study:
- To report the 5-year clinical outcomes of patients undergoing on-pump versus off-pump CABG.
- To compare all-cause mortality and major adverse cardiovascular events between the two surgical methods.
Main Methods:
- A randomized trial involving 2203 patients at 18 medical centers.
- Patients were assigned to either on-pump or off-pump CABG.
- Primary outcomes assessed at 5 years included all-cause death and a composite of major adverse cardiovascular events.
Main Results:
- Five-year all-cause mortality was higher in the off-pump group (15.2%) versus the on-pump group (11.9%).
- Major adverse cardiovascular events at 5 years were also higher in the off-pump group (31.0%) compared to the on-pump group (27.1%).
- No significant differences were observed for secondary outcomes like nonfatal myocardial infarction or cardiac death.
Conclusions:
- Off-pump CABG was associated with lower rates of 5-year survival and event-free survival compared to on-pump CABG.
- The findings suggest potential differences in long-term clinical outcomes between the two CABG techniques.
Background:
Coronary-artery bypass grafting (CABG) surgery may be performed either with cardiopulmonary bypass (on pump) or without cardiopulmonary bypass (off pump). We report the 5-year clinical outcomes in patients who had been included in the Veterans Affairs trial of on-pump versus off-pump CABG.
Methods:
From February 2002 through June 2007, we randomly assigned 2203 patients at 18 medical centers to undergo either on-pump or off-pump CABG, with 1-year assessments completed by May 2008. The two primary 5-year outcomes were death from any cause and a composite outcome of major adverse cardiovascular events, defined as death from any cause, repeat revascularization (CABG or percutaneous coronary intervention), or nonfatal myocardial infarction. Secondary 5-year outcomes included death from cardiac causes, repeat revascularization, and nonfatal myocardial infarction. Primary outcomes were assessed at a P value of 0.05 or less, and secondary outcomes at a P value of 0.01 or less.
Results:
The rate of death at 5 years was 15.2% in the off-pump group versus 11.9% in the on-pump group (relative risk, 1.28; 95% confidence interval [CI], 1.03 to 1.58; P=0.02). The rate of major adverse cardiovascular events at 5 years was 31.0% in the off-pump group versus 27.1% in the on-pump group (relative risk, 1.14; 95% CI, 1.00 to 1.30; P=0.046). For the 5-year secondary outcomes, no significant differences were observed: for nonfatal myocardial infarction, the rate was 12.1% in the off-pump group and 9.6% in the on-pump group (P=0.05); for death from cardiac causes, the rate was 6.3% and 5.3%, respectively (P=0.29); for repeat revascularization, the rate was 13.1% and 11.9%, respectively (P=0.39); and for repeat CABG, the rate was 1.4% and 0.5%, respectively (P=0.02).
Conclusions:
In this randomized trial, off-pump CABG led to lower rates of 5-year survival and event-free survival than on-pump CABG. (Funded by the Department of Veterans Affairs Office of Research and Development Cooperative Studies Program and others; ROOBY-FS ClinicalTrials.gov number, NCT01924442 .).
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