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Published on: September 15, 2023
Long-Term Outcomes of On- Versus Off-Pump Coronary Artery Bypass Grafting
Neil A Smart1, Gudrun Dieberg1, Nicola King2
1School of Science and Technology, University of New England, Armidale, Australia.
Insights
On-pump coronary artery bypass grafting (CABG) shows statistically superior long-term survival compared to off-pump CABG. However, the clinical significance of this survival benefit requires further investigation.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Meta-Analysis and Systematic Review
Background:
- Assessing long-term clinical outcomes of on-pump versus off-pump coronary artery bypass grafting (CABG) is crucial.
- Existing research predominantly focuses on short-term results, neglecting crucial 5-year outcomes from major trials.
Purpose of the Study:
- To conduct a systematic review and meta-analysis evaluating long-term clinical outcomes after on-pump versus off-pump CABG.
- To specifically analyze 5-year outcomes, including mortality, myocardial infarction, angina, revascularization, and stroke incidence.
Main Methods:
- Systematic literature searches were performed across multiple databases.
- Search terms included 'cardiopulmonary bypass,' 'off-pump,' and 'long term OR 5-year outcomes.'
- A meta-analysis compared key clinical endpoints between on-pump and off-pump CABG groups.
Main Results:
- Analysis of six studies involving 8,145 participants revealed a statistically significant higher mortality in the off-pump group (13.9%) compared to the on-pump group (12.3%) (OR: 1.16; p=0.03).
- No significant differences were observed in the incidence of myocardial infarction (OR: 1.06), angina (OR: 1.09), need for revascularization (OR: 1.15), or stroke (OR: 0.78) between the two groups.
- Confidence intervals for non-mortality outcomes indicated no statistically significant differences.
Conclusions:
- On-pump CABG demonstrated a statistically significant advantage in long-term survival.
- The clinical relevance of this survival difference warrants further consideration and investigation.
- Long-term outcomes beyond mortality did not differ significantly between on-pump and off-pump CABG.
Background:
When comparing effects of on- versus off-pump coronary artery bypass grafting (CABG), it is important to assess the long-term clinical outcomes. However, most research conducted thus far has concentrated on short-term outcomes and ignored the long-term clinical outcomes, especially the 5-year outcomes of the largest randomized controlled trials.
Objectives:
The aim of this systematic review and meta-analysis was to investigate the long-term clinical outcomes of on- versus off-pump CABG.
Methods:
To identify potential studies systematic searches were carried out using various databases. The search strategy included the key concepts of cardiopulmonary bypass AND off-pump AND long term OR 5-year outcomes. This was followed by a meta-analysis investigating mortality, incidence of myocardial infarction, incidence of angina, need for revascularization, and incidence of stroke.
Results:
Six studies totaling 8,145 participants were analyzed. In the on-pump group mortality was 12.3%, compared with 13.9% in the off-pump group. The odds ratio (OR) for this comparison was 1.16 (95% confidence interval [CI]: 1.02 to 1.32; p = 0.03; 13.9% vs. 12.3%). In contrast, there were no differences in the incidence of myocardial infarction (OR: 1.06: 95% CI: 0.91 to 1.25; p = 0.45; 8.4% vs. 7.9%), incidence of angina (OR: 1.09; 95% CI: 0.75 to 1.57; p = 0.65; 2.3% vs. 2.1%), need for revascularization (OR: 1.15; 95% CI: 0.95 to 1.40; p = 0.16; 5.9% vs. 5.1%), and the incidence of stroke (OR: 0.78; 95% CI: 0.56 to 1.10; p = 0.16; 2.2% vs. 2.8%).
Conclusions:
Statistically, on-pump CABG appeared to offer superior long-term survival, although the clinical significance of this may be more uncertain.
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