Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting
André Lamy, P J Devereaux, Dorairaj Prabhakaran, David P Taggart, Shengshou Hu, Zbynek Straka, Leopoldo S Piegas, Alvaro Avezum, Ahmet R Akar, Fernando Lanas Zanetti, Anil R Jain, Nicolas Noiseux, Chandrasekar Padmanabhan, Juan-Carlos Bahamondes, Richard J Novick, Liang Tao, Pablo A Olavegogeascoechea, Balram Airan, Toomas-Andres Sulling, Richard P Whitlock, Yongning Ou, Peggy Gao, Shirley Pettit, Salim Yusuf, CORONARY Investigators, R Cartier, S Chocron, S E Fremes, P J Lopez, L Martinelli, J Murkin, J A Cairns, F Dagenais, D Follmann, H J Nathan, F L Silver, G Fodor, E Belley-Cote, E Duceppe, S Hussain, A Bessissow, J Khan, L Robinson, T Miranda, J Vincent, J A Abud, H Cacheda, J P Casal, M C Escarain, R R Favaloro, W D Ferrara, P E Giner, A G Girela, J M Quiroga, H A Raffaelli, G Valenzuela, P G Bannon, M P Vallely, D M Braile, E Buffolo, E G Chamlian, F D A Costa, A D Ferreira, J B Oliveira, A C Oliveira Freitas, N A Stolf, J C Guilhen, W Hueb, J C Leal, F A Lucchese, A C Penna, A C Pires, L A Rivetti, A M Rösler, D C Vila Nova, F Basile, C Bergeron, A Cheung, M W A Chu, R J Cusimano, A Dyub, D M Greentree, L R Guo, B Kiaii, T M Kieser, F Moussa, J Noora, L P Perrault, I Prieto, L M Stevens, L Trombetta, T M Yau, X Chen, X Chen, C Gao, J Gao, S Gu, T Gu, H Huang, S Jiang, G Liu, F Lv, X Meng, X Pan, P Su, X Sun, L Tan, C Wang, C Wang, R Wang, S Xue, J Yang, D Yi, H Yu, H Zhang, G Zhao, Q Zhao, Z Zheng, H Zhou, X Zhou, E A Cadavid, V R Castillo, T Chalela, A Figueredo, N F Sandoval, R Brat, T Danek, J Harrer, J Hlavicka, M Holubec, T Holubec, A Kraupnerova, V Mikulenka, M Setina, T Vanek, K Vik, P Zacek, M Alver, H Vähi, S Sulling, D Kaili, S K Agarwal, K V Arunachalam, K Cherian, S K Choudhary, A G Gokhale, V M Gupta, M P Hote, R Jose, G Karthikeyan, U Kaul, D Kodem, S Kumar, G S Madathana Palli, A R Malempati, B R Malipeddi, Y K Mishra, K Padhy, S Pande, V Pithva, S V Ponangi, S K Reddy, N C Reddy, A Saxena, B Shankar, A Shankar, M Shanmugam, N Sinha, M Srinivasan, A Thakor, P Vaijyanath, P K Varma, M P Vettath, K Singh, R Devarajan, M Agostini, L Passini, S Pelenghi, M Bentala, M J Arbeus, D R De Souza, M Cakici, S Durdu, K Kaya, E Ozcinar, E Sener, A Telli, E Uguz, O Gogayeva, A Rudenko, I J Birdi, K Godsell, A J Ritchie, C M Wallis, V Zamvar, D Chafes, O Montaña, K F Huang, S V Parvathaneni, André Lamy, P J Devereaux, Dorairaj Prabhakaran, David P Taggart, Shengshou Hu, Zbynek Straka, Leopoldo S Piegas, Alvaro Avezum, Ahmet R Akar, Fernando Lanas Zanetti, Anil R Jain, Nicolas Noiseux, Chandrasekar Padmanabhan, Juan-Carlos Bahamondes, Richard J Novick, Liang Tao, Pablo A Olavegogeascoechea, Balram Airan, Toomas-Andres Sulling, Richard P Whitlock, Yongning Ou, Peggy Gao, Shirley Pettit, Salim Yusuf, CORONARY Investigators, R Cartier, S Chocron, S E Fremes, P J Lopez, L Martinelli, J Murkin, J A Cairns, F Dagenais, D Follmann, H J Nathan, F L Silver, G Fodor, E Belley-Cote, E Duceppe, S Hussain, A Bessissow, J Khan, L Robinson, T Miranda, J Vincent, J A Abud, H Cacheda, J P Casal, M C Escarain, R R Favaloro, W D Ferrara, P E Giner, A G Girela, J M Quiroga, H A Raffaelli, G Valenzuela, P G Bannon, M P Vallely, D M Braile, E Buffolo, E G Chamlian, F D A Costa, A D Ferreira, J B Oliveira, A C Oliveira Freitas, N A Stolf, J C Guilhen, W Hueb, J C Leal, F A Lucchese, A C Penna, A C Pires, L A Rivetti, A M Rösler, D C Vila Nova, F Basile, C Bergeron, A Cheung, M W A Chu, R J Cusimano, A Dyub, D M Greentree, L R Guo, B Kiaii, T M Kieser, F Moussa, J Noora, L P Perrault, I Prieto, L M Stevens, L Trombetta, T M Yau, X Chen, X Chen, C Gao, J Gao, S Gu, T Gu, H Huang, S Jiang, G Liu, F Lv, X Meng, X Pan, P Su, X Sun, L Tan, C Wang, C Wang, R Wang, S Xue, J Yang, D Yi, H Yu, H Zhang, G Zhao, Q Zhao, Z Zheng, H Zhou, X Zhou, E A Cadavid, V R Castillo, T Chalela, A Figueredo, N F Sandoval, R Brat, T Danek, J Harrer, J Hlavicka, M Holubec, T Holubec, A Kraupnerova, V Mikulenka, M Setina, T Vanek, K Vik, P Zacek, M Alver, H Vähi, S Sulling, D Kaili, S K Agarwal, K V Arunachalam, K Cherian, S K Choudhary, A G Gokhale, V M Gupta, M P Hote, R Jose, G Karthikeyan, U Kaul, D Kodem, S Kumar, G S Madathana Palli, A R Malempati, B R Malipeddi, Y K Mishra, K Padhy, S Pande, V Pithva, S V Ponangi, S K Reddy, N C Reddy, A Saxena, B Shankar, A Shankar, M Shanmugam, N Sinha, M Srinivasan, A Thakor, P Vaijyanath, P K Varma, M P Vettath, K Singh, R Devarajan, M Agostini, L Passini, S Pelenghi, M Bentala, M J Arbeus, D R De Souza, M Cakici, S Durdu, K Kaya, E Ozcinar, E Sener, A Telli, E Uguz, O Gogayeva, A Rudenko, I J Birdi, K Godsell, A J Ritchie, C M Wallis, V Zamvar, D Chafes, O Montaña, K F Huang, S V Parvathaneni
Abstract
Background: We previously reported that there was no significant difference at 30 days or at 1 year in the rate of the composite outcome of death, stroke, myocardial infarction, or renal failure between patients who underwent coronary-artery bypass grafting (CABG) performed with a beating-heart technique (off-pump) and those who underwent CABG performed with cardiopulmonary bypass (on-pump). We now report the results at 5 years (the end of the trial).
Methods: A total of 4752 patients (from 19 countries) who had coronary artery disease were randomly assigned to undergo off-pump or on-pump CABG. For this report, we analyzed a composite outcome of death, stroke, myocardial infarction, renal failure, or repeat coronary revascularization (either CABG or percutaneous coronary intervention). The mean follow-up period was 4.8 years.
Results: There were no significant differences between the off-pump group and the on-pump group in the rate of the composite outcome (23.1% and 23.6%, respectively; hazard ratio with off-pump CABG, 0.98; 95% confidence interval [CI], 0.87 to 1.10; P=0.72) or in the rates of the components of the outcome, including repeat coronary revascularization, which was performed in 2.8% of the patients in the off-pump group and in 2.3% of the patients in the on-pump group (hazard ratio, 1.21; 95% CI, 0.85 to 1.73; P=0.29). The secondary outcome for the overall period of the trial - the mean cost in U.S. dollars per patient - also did not differ significantly between the off-pump group and the on-pump group ($15,107 and $14,992, respectively; between-group difference, $115; 95% CI, -$697 to $927). There were no significant between-group differences in quality-of-life measures.
Conclusions: In our trial, the rate of the composite outcome of death, stroke, myocardial infarction, renal failure, or repeat revascularization at 5 years of follow-up was similar among patients who underwent off-pump CABG and those who underwent on-pump CABG. (Funded by the Canadian Institutes of Health Research; CORONARY ClinicalTrials.gov number, NCT00463294 .).
Source: PubMed