[Long-term outcomes after Off-Pump versus On-Pump coronary artery bypass grafting in Iceland]

Most studies comparing Off-pump and On-pump coronary artery bypass grafting (CABG) have primarily focused on short-term outcomes. The aim of this study was therefore to evaluate and compare long-term complications and survival between these surgical approaches.

This retrospective study included 2337 patients who underwent primary isolated CABG in Iceland between 2001-2021; 397 (17,0%) performed Off-Pump and 1940 (83,0%) On-Pump. The complications stroke, myocardial infarction (MI), percutaneous coronary intervention (PCI), repeat CABG and death; combined as major adverse cardiovascular and cerebrovascular events (MACCE), were compared between the groups after 1:1 propensity score matching (377 pairs). Long-term survival and MACCE-free survival were estimated using the Kaplan-Meier method and multivariable Cox regression.

Before matching, patients in the On-Pump group had more extensive coronary artery disease and were more often operated on acutely. At 10-year follow-up, the cumulative incidence of PCI (14.0% in the Off-Pump group vs. 10.2% in the On-Pump group, p=0.110), MI (9.0% vs. 8.0%, p=0.784), stroke (4.6% vs. 6.8%, p=0.090) and repeat CABG (0.9% vs. 0.0%, p=0.090) were comparable between groups in the matched cohort. MACCE-free survival (71.0% in the Off-Pump group vs. 71.4% in the On-Pump group, p=0.74) and overall survival (78.5% vs. 73.2%, p=0.095) at 10 years was also comparable between groups. Furthermore, multivariate analysis showed similar overall survival for both surgical techniques (HR: 0.81; 95%-CI: 0.60-1.09; p=0,156).

The long-term outcomes following CABG in Iceland are favorable for both Off-pump and On-pump procedures, both in terms of survival and long-term complications.