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Updated: Jun 6, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Survival and Mid-Term Outcomes of On Pump vs. Off Pump Coronary Artery Bypass Grafting: A Propensity Score-Matched
W Samir Cubas1, Wildor Dongo-Minaya2, Franco Albán-Sánchez1
1Department of Thoracic and Cardiovascular Surgery, Heart Surgery Service, Edgardo Rebagliati Martins National Hospital, Lima, Peru.
Insights
Off-pump coronary artery bypass grafting (CABG) showed better outcomes than on-pump CABG in Peru. This study found lower mortality and better survival rates for off-pump procedures.
Area of Science:
- Cardiovascular Surgery
- Medical Registries
- Comparative Effectiveness
Background:
- Efficacy of on-pump versus off-pump coronary artery bypass grafting (CABG) is uncertain, particularly in Latin America.
- The first Peruvian registry of CABG patients is utilized to compare these techniques.
Purpose of the Study:
- To explore survival and short- to mid-term outcomes of on-pump and off-pump CABG.
- To analyze data from the initial Peruvian CABG patient registry.
Main Methods:
- Observational, analytical, longitudinal study with propensity score-matched (PSM) analysis.
- Retrospective registry of 2280 patients (2000-2019), with 846 patients analyzed post-PSM (423 on-pump vs. 423 off-pump).
- Comparison of short-term (≤30 days) and mid-term (30 days-36 months) outcomes, including major adverse cardiac and cerebrovascular events, using descriptive, multivariate, and Kaplan-Meier analyses.
Main Results:
- After PSM, off-pump CABG had higher pre-surgery percutaneous coronary intervention and STS risk scores.
- On-pump CABG was associated with higher short-term mortality, blood transfusion, reintervention, hospital stay, arrhythmia, and renal failure.
- On-pump CABG also showed higher long-term mortality, myocardial infarction, and repeat revascularization rates, with lower 36-month adjusted survival (93.63% vs. 97.88%).
Conclusions:
- Off-pump CABG demonstrated lower short- and mid-term morbidity and mortality.
- Off-pump CABG is associated with better adjusted survival rates compared to on-pump CABG in this Peruvian cohort.
- Further multicenter studies in Latin America are recommended to confirm these findings.
Introduction:
The efficacy and outcomes of on-pump and off-pump coronary artery bypass grafting (CABG) remain uncertain, especially in Latin America. Our study aims to explore survival and shortand mid-term outcomes in the first reported Peruvian registry of patients treated with both techniques.
Methods:
This is an observational, analytical, and longitudinal study using a propensity score-matched (PSM) analysis in a single-center retrospective registry of 2280 patients during 2000-2019; 846 patients were analyzed after PSM (on-pump = 423 vs. off-pump = 423). Baseline variables, comorbidities, and major outcomes were studied in the short term (≤ 30 days) and in midterm (30 days-36 months) with major adverse cardiac and cerebrovascular events. The matched groups were compared by descriptive, multivariate, and Kaplan-Meier survival analyses.
Results:
Before PSM, previous myocardial infarction < 7 days (27.03%) and ejection fraction ≥ 50% (45.72%) were higher in off-pump CABG (P<0.05). After PSM, pre-surgery percutaneous coronary intervention (27.18% vs. 26.71%, P=0.049) and Society of Thoracic Surgeons risk score (1.98% vs. 1.90%, P=0.047) were higher in off-pump CABG. In the short term, there was higher mortality (2.12% vs. 0.47%, P=0.048), blood transfusion > 500 ml (57.91% vs. 7.56%, P=0.049), reintervention (7.32% vs. 2.12%, P=0.045), hospital stay (nine vs. four days, P=0.048), arrhythmia (9.92% vs. 4.96%, P=0.049), and renal failure (20.09% vs. 5.91%, P=0.009) in on-pump CABG. Long-term mortality (4.25% vs. 1.65%, P=0.044), myocardial infarction (17.02% vs. 7.32%, P=0.046), and repeat revascularization (17.49% vs. 8.26%, P=0.045) predominated in on-pump CABG. There was a higher 36-month adjusted survival for off-pump over on-pump CABG (97.88% vs. 93.63%, P=0.046).
Conclusion:
This first reported Peruvian registry of patients treated with CABG has demonstrated that off-pump CABG is associated with lower shortand mid-term morbidity and mortality rates and better-adjusted survival rates compared to on-pump CABG; however, further multicenter studies in Latin America are needed to elucidate its benefits over classic on-pump CABG.
