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Published on: November 24, 2014
Mid-term outcomes of off-pump versus on-pump coronary artery bypass graft surgery; statistical challenges in
Ali Sheikhy1, Aida Fallahzadeh1, Saeed Sadeghian2
1Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Off-pump coronary artery bypass grafting (CABG) shows similar 30-day mortality and mid-term outcomes compared to on-pump CABG. Off-pump surgery may offer short-term cost-effectiveness, with comparable survival and major adverse cardiac and cerebrovascular events (MACCE).
Area of Science:
- Cardiovascular Surgery
- Medical Technology
- Clinical Outcomes Research
Background:
- The comparative effectiveness of off-pump versus on-pump coronary artery bypass grafting (CABG) remains a subject of ongoing research.
- Uncertainty persists regarding the long-term outcomes and safety profiles of off-pump CABG procedures.
Purpose of the Study:
- To evaluate and compare the clinical outcomes and effectiveness of off-pump versus on-pump CABG.
- To assess the 30-day mortality, mid-term survival, and major adverse cardiac and cerebrovascular events (MACCE) between the two surgical approaches.
Main Methods:
- A registry-based study involving 8163 patients undergoing isolated CABG between 2014 and 2016.
- Utilized propensity score matching (PSM), inverse probability of weighting (IPW), and covariate adjustment to mitigate selection bias.
- Followed patients for an average of 36.1 months to analyze mid-term outcomes.
Main Results:
- Patients undergoing off-pump CABG experienced shorter hospitalization, intubation time, and ICU stays.
- Unadjusted analysis showed a higher risk of 30-day mortality with off-pump CABG, but this difference was not significant after adjustment and matching.
- After adjustment, no significant differences were observed in mid-term MACCE or all-cause mortality between off-pump and on-pump CABG.
Conclusions:
- Both off-pump and on-pump CABG demonstrate comparable 30-day mortality rates when adjusted for confounding factors.
- Off-pump surgery may be more cost-effective in the short term.
- Mid-term survival and MACCE rates are similar for both off-pump and on-pump CABG techniques.
Background:
Despite several studies comparing off- and on-pump coronary artery bypass grafting (CABG), the effectiveness and outcomes of off-pump CABG still remain uncertain.
Methods:
In this registry-based study, we assessed 8163 patients who underwent isolated CABG between 2014 and 2016. Propensity score matching (PSM), inverse probability of weighting (IPW) and covariate adjustment were performed to correct for and minimize selection bias.
Results:
The overall mean age of the patients was 62 years, and 25.7% were women. Patients who underwent off-pump CABG had shorter length of hospitalization (p < 0.001), intubation time (p = 0.003) and length of ICU admission (p < 0.001). Off-pump CABG was associated with higher risk of 30-days mortality (OR: 1.7; 95% CI 1.09-2.65; p = 0.019) in unadjusted analysis. After covariate adjustment and matching (PSM and IPW), this difference was not statistically significant. After an average of 36.1 months follow-up, risk of MACCE and all-cause mortality didn't have significant differences in both surgical methods by adjusting with IPW (HR: 1.03; 95% CI 0.87-1.24; p = 0.714; HR: 0.91; 95% CI 0.73-1.14; p = 578, respectively).
Conclusion:
Off-pump and on-pump techniques have similar 30-day mortality (adjusted, PSM and IPW). Off-pump surgery is probably more cost-effective in short term; however, mid-term survival and MACCE trends in both surgical methods are comparable.
