Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year
André Lamy, P J Devereaux, Dorairaj Prabhakaran, David P Taggart, Shengshou Hu, Ernesto Paolasso, Zbynek Straka, Leopoldo S Piegas, Ahmet Ruchan Akar, Anil R Jain, Nicolas Noiseux, Chandrasekar Padmanabhan, Juan-Carlos Bahamondes, Richard J Novick, Prashant Vaijyanath, Sukesh Kumar Reddy, Liang Tao, Pablo A Olavegogeascoechea, Balram Airan, Toomas-Andres Sulling, Richard P Whitlock, Yongning Ou, Janice Pogue, Susan Chrolavicius, Salim Yusuf, CORONARY Investigators, S Yusuf, D P Taggart, A Lamy, A R Akar, A Avezum, R Cartier, S Chocron, S Chrolavicius, P J Devereaux, P Dorairaj, S E Fremes, S Hu, F Lanas, P J Lopez, L Martinelli, J Murkin, R J Novick, E Paolasso, L Piegas, Z Straka, J A Cairns, F Dagenais, D Follmann, H J Nathan, F L Silver, A Avezum, F Botto, A Dyub, G Fodor, J Healey, S Jolly, M Lawrence, G Lurati, K Malikov, C Morillo, S Chrolavicius, Y Ou, B Jedrzejowski, M Lawrence, L Floyd, R Manojlovic, J Ng, E Pasadyn, J Pogue, L Robinson, J Vincent, A Lamy, P J Devereaux, R Whitlock, S Yusuf, J A Abud, G Aventín, H Cacheda, J P Casal, J A Collantes, M C Escarain, R R Favaloro, W D Ferrara, P E Giner, A G Girela, P A Olavegogeascoechea, J M Quiroga, H A Raffaelli, G Valenzuela, P G Bannon, M P Vallely, R T Barros, D M Braile, E Buffolo, E G Chamlian, F D A Costa, M de Cunha Sales, B C de Oliveira, J B P de Oliveira, F de Rueda, L C B de Sousa, P Farsky, A D de A Ferreira, J D Frota, N A Groppo Stolf, J C S Guilhen, A C Hueb, W Hueb, M Issa, F B Jatene, J C Leal, R Lima, F A Lucchese, C Moraes, F Moraes, H Muzio, A C Oliveira Freitas, A C Penna, A C Pires, L A Rivetti, A M Rösler, L E V C Seixas, D C Vila Nova, P Smith, F Basile, R Cartier, A W-C Cheung, R J Cusimano, A Dyub, N Esmaeili, S A Fox, S E Fremes, D M Greentree, L Guo, B Kiaii, T M Kieser, A Lamy, F Moussa, N Noiseux, L Normandin, R J Novick, L P Perrault, I Prieto, T Rizzo, L M Stevens, F Toito, T M Yau, J Ye, J C Bahamondes, G H Meriño, J A Salman, A A Silva, M A Villavicencio, X An, X Chen, X Chen, C Gao, S Gu, T Gu, S Hu, Y Kong, H Lai, Y Liu, X Meng, X Pan, P Su, X Sun, H Tang, L Tao, C Wang, C Wang, L Wang, R Wang, W Wang, Y Wang, Y Wu, L Xia, M Xu, S Xue, J Yang, D Yi, H Yu, H Zhang, Q Zhao, Z Zheng, H Zhou, X Zhou, A J Borrero, E A Cadavid, V R Castillo, T Chalela, A Figueredo, A S Machuca, N F Sandoval, R Brat, T Danek, J Harrer, J Hlavicka, Z Holubcova, T Holubec, S Jelinek, V Mikulenka, M Setina, Z Straka, T Vanek, K Vik, P Zacek, M Alver, T A Sulling, H Vähi, S Chocron, D Kaili, S K Agarwal, B Airan, K V Arunachalam, D R Ayapati, S K Choudhary, S B Ganesh, A G Gokhale, V M Gupta, M P Hote, A R Jain, U Kaul, S Kumar, B R Malipeddi, B S Mallya, Y K Mishra, R V Modi, A P Mohammed, S K Nair, K Padhy, C Padmanabhan, S Pande, C R Podduturi Naveen, S V Ponangi, S K Reddy, N Sinha, M Srinivasan, A Sundar, M S Thomas, P Vaijyanath, M P Vettath, Kavita, M Agostini, V Di Gregorio, L Martinelli, S Pelenghi, M Bentala, M J Arbeus, D R De Souza, A R Akar, S Aykut Aka, C Baran, S Durdu, M Hidiroglu, D Kahraman, K Kaya, E Sener, V Sinci, C Zaim, O Gogayeva, A Rudenko, I Birdi, S Lloyd, A J Ritchie, D P Taggart, V Zamvar, D Chafes, O Montaña, K F Huang, S V Parvathaneni, R L Tourville, André Lamy, P J Devereaux, Dorairaj Prabhakaran, David P Taggart, Shengshou Hu, Ernesto Paolasso, Zbynek Straka, Leopoldo S Piegas, Ahmet Ruchan Akar, Anil R Jain, Nicolas Noiseux, Chandrasekar Padmanabhan, Juan-Carlos Bahamondes, Richard J Novick, Prashant Vaijyanath, Sukesh Kumar Reddy, Liang Tao, Pablo A Olavegogeascoechea, Balram Airan, Toomas-Andres Sulling, Richard P Whitlock, Yongning Ou, Janice Pogue, Susan Chrolavicius, Salim Yusuf, CORONARY Investigators, S Yusuf, D P Taggart, A Lamy, A R Akar, A Avezum, R Cartier, S Chocron, S Chrolavicius, P J Devereaux, P Dorairaj, S E Fremes, S Hu, F Lanas, P J Lopez, L Martinelli, J Murkin, R J Novick, E Paolasso, L Piegas, Z Straka, J A Cairns, F Dagenais, D Follmann, H J Nathan, F L Silver, A Avezum, F Botto, A Dyub, G Fodor, J Healey, S Jolly, M Lawrence, G Lurati, K Malikov, C Morillo, S Chrolavicius, Y Ou, B Jedrzejowski, M Lawrence, L Floyd, R Manojlovic, J Ng, E Pasadyn, J Pogue, L Robinson, J Vincent, A Lamy, P J Devereaux, R Whitlock, S Yusuf, J A Abud, G Aventín, H Cacheda, J P Casal, J A Collantes, M C Escarain, R R Favaloro, W D Ferrara, P E Giner, A G Girela, P A Olavegogeascoechea, J M Quiroga, H A Raffaelli, G Valenzuela, P G Bannon, M P Vallely, R T Barros, D M Braile, E Buffolo, E G Chamlian, F D A Costa, M de Cunha Sales, B C de Oliveira, J B P de Oliveira, F de Rueda, L C B de Sousa, P Farsky, A D de A Ferreira, J D Frota, N A Groppo Stolf, J C S Guilhen, A C Hueb, W Hueb, M Issa, F B Jatene, J C Leal, R Lima, F A Lucchese, C Moraes, F Moraes, H Muzio, A C Oliveira Freitas, A C Penna, A C Pires, L A Rivetti, A M Rösler, L E V C Seixas, D C Vila Nova, P Smith, F Basile, R Cartier, A W-C Cheung, R J Cusimano, A Dyub, N Esmaeili, S A Fox, S E Fremes, D M Greentree, L Guo, B Kiaii, T M Kieser, A Lamy, F Moussa, N Noiseux, L Normandin, R J Novick, L P Perrault, I Prieto, T Rizzo, L M Stevens, F Toito, T M Yau, J Ye, J C Bahamondes, G H Meriño, J A Salman, A A Silva, M A Villavicencio, X An, X Chen, X Chen, C Gao, S Gu, T Gu, S Hu, Y Kong, H Lai, Y Liu, X Meng, X Pan, P Su, X Sun, H Tang, L Tao, C Wang, C Wang, L Wang, R Wang, W Wang, Y Wang, Y Wu, L Xia, M Xu, S Xue, J Yang, D Yi, H Yu, H Zhang, Q Zhao, Z Zheng, H Zhou, X Zhou, A J Borrero, E A Cadavid, V R Castillo, T Chalela, A Figueredo, A S Machuca, N F Sandoval, R Brat, T Danek, J Harrer, J Hlavicka, Z Holubcova, T Holubec, S Jelinek, V Mikulenka, M Setina, Z Straka, T Vanek, K Vik, P Zacek, M Alver, T A Sulling, H Vähi, S Chocron, D Kaili, S K Agarwal, B Airan, K V Arunachalam, D R Ayapati, S K Choudhary, S B Ganesh, A G Gokhale, V M Gupta, M P Hote, A R Jain, U Kaul, S Kumar, B R Malipeddi, B S Mallya, Y K Mishra, R V Modi, A P Mohammed, S K Nair, K Padhy, C Padmanabhan, S Pande, C R Podduturi Naveen, S V Ponangi, S K Reddy, N Sinha, M Srinivasan, A Sundar, M S Thomas, P Vaijyanath, M P Vettath, Kavita, M Agostini, V Di Gregorio, L Martinelli, S Pelenghi, M Bentala, M J Arbeus, D R De Souza, A R Akar, S Aykut Aka, C Baran, S Durdu, M Hidiroglu, D Kahraman, K Kaya, E Sener, V Sinci, C Zaim, O Gogayeva, A Rudenko, I Birdi, S Lloyd, A J Ritchie, D P Taggart, V Zamvar, D Chafes, O Montaña, K F Huang, S V Parvathaneni, R L Tourville
Abstract
Background: Previously, we reported that there was no significant difference at 30 days in the rate of a primary composite outcome of death, myocardial infarction, stroke, or new renal failure requiring dialysis 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 results on quality of life and cognitive function and on clinical outcomes at 1 year.
Methods: We enrolled 4752 patients with coronary artery disease who were scheduled to undergo CABG and randomly assigned them to undergo the procedure off-pump or on-pump. Patients were enrolled at 79 centers in 19 countries. We assessed quality of life and cognitive function at discharge, at 30 days, and at 1 year and clinical outcomes at 1 year.
Results: At 1 year, there was no significant difference in the rate of the primary composite outcome between off-pump and on-pump CABG (12.1% and 13.3%, respectively; hazard ratio with off-pump CABG, 0.91; 95% confidence interval [CI], 0.77 to 1.07; P=0.24). The rate of the primary outcome was also similar in the two groups in the period between 31 days and 1 year (hazard ratio, 0.79; 95% CI, 0.55 to 1.13; P=0.19). The rate of repeat coronary revascularization at 1 year was 1.4% in the off-pump group and 0.8% in the on-pump group (hazard ratio, 1.66; 95% CI, 0.95 to 2.89; P=0.07). There were no significant differences between the two groups at 1 year in measures of quality of life or neurocognitive function.
Conclusions: At 1 year after CABG, there was no significant difference between off-pump and on-pump CABG with respect to the primary composite outcome, the rate of repeat coronary revascularization, quality of life, or neurocognitive function. (Funded by the Canadian Institutes of Health Research; CORONARY ClinicalTrials.gov number, NCT00463294.).
Source: PubMed