Five-Year Outcomes after On-Pump and Off-Pump Coronary-Artery Bypass
A Laurie Shroyer, Brack Hattler, Todd H Wagner, Joseph F Collins, Janet H Baltz, Jacquelyn A Quin, G Hossein Almassi, Elizabeth Kozora, Faisal Bakaeen, Joseph C Cleveland Jr, Muath Bishawi, Frederick L Grover, Veterans Affairs ROOBY-FS Group, Sarah Vernon, Stuart Pett, Charles Dietl, Jorge Wernly, Jeannie Collatz, John Lucke, Peter McKeown, John Kellemen, Mariette Coyle, Keith Nicalo, Diana Whittlesey, Christiano Calderia, Brian Cmolik, Barbara Bauer, Michael Jessen, Michael Dimaio, John Sum‐Ping, Wanda Frey, Michele Roesle, Alden Harken, Shauna Brennan, Walter Wolfe, Carmelo Milano, Kevin Landolpho, Shu Lin, James Lowe, Jean Kistler, Felipe Urdaneta, Richard Schofield, Edward Staples, Thomas Beaver, Terry Glover, Jan Hutchinson, Kristine Wynne, Eugene Grossi, Gregory Crooke, Alfred Culliford, Charles Schwartz, George Gogoladze, Estelita Anteola, Abbas Ardehali, Denis Baker, Fardad Esmailian, Ramin Beygui, Ramin Ebrahimi, Eileen Ziff, Rebecca Lopez, Kushagra Katariya, Richard Thurer, Michele Landi, Alfred Nicolosi, Sharon Pecsi, John Giacomini, Thomas Burdon, James Fann, Gerald Georgette, Dong Yu, Ali Sonel, Marco Zenati, Larry Shears, Lawrence Wei, Kenneth McCurry, Robert Kormos, Jennifer Gabany, Kathleen Ross, Alanna Macioce, Pasala Ravichandran, John Blizzard, Matt Slatter, Howard Song, Karina Dana, Volio Kesic, Mark Ratcliffe, Jon Baker, Timothy Hall, Michael Mann, T Sloane Guy, Elaine Tseng, Mary Jane Wood, Edward Sako, Gregory Freeman, Andrea Carpenter, Daniel Martinez, V Sreenath Reddy, Regina Whitener, Dimitri Novitzky, Jennifer Darter, Jennifer Shippy, Rebecca Reinhard, Pendleton Alexander, Greg Trachiotis, Mary Bloom, Elizabeth Wyman, Frederick L Grover, Susan Kongs, Michael Hampton, John Messenger, Scott J Haugen, Joel A Garcia, Lisa Schade, Krisann Bruton, Marianne Medlin, Brittany Coker, Christine Dalzell, Darlene Kemp, Jeanie Kim, Shirley Lu, Ellen Sterrett, Annette Wiseman, Timothy J O’Leary, Grant D Huang, John S Rumsfeld, John A Spertus, Fred Edwards, Adam Chow, Hao Jian, Teresa Kulas, A Laurie Shroyer, Brack Hattler, Todd H Wagner, Joseph F Collins, Janet H Baltz, Jacquelyn A Quin, G Hossein Almassi, Elizabeth Kozora, Faisal Bakaeen, Joseph C Cleveland Jr, Muath Bishawi, Frederick L Grover, Veterans Affairs ROOBY-FS Group, Sarah Vernon, Stuart Pett, Charles Dietl, Jorge Wernly, Jeannie Collatz, John Lucke, Peter McKeown, John Kellemen, Mariette Coyle, Keith Nicalo, Diana Whittlesey, Christiano Calderia, Brian Cmolik, Barbara Bauer, Michael Jessen, Michael Dimaio, John Sum‐Ping, Wanda Frey, Michele Roesle, Alden Harken, Shauna Brennan, Walter Wolfe, Carmelo Milano, Kevin Landolpho, Shu Lin, James Lowe, Jean Kistler, Felipe Urdaneta, Richard Schofield, Edward Staples, Thomas Beaver, Terry Glover, Jan Hutchinson, Kristine Wynne, Eugene Grossi, Gregory Crooke, Alfred Culliford, Charles Schwartz, George Gogoladze, Estelita Anteola, Abbas Ardehali, Denis Baker, Fardad Esmailian, Ramin Beygui, Ramin Ebrahimi, Eileen Ziff, Rebecca Lopez, Kushagra Katariya, Richard Thurer, Michele Landi, Alfred Nicolosi, Sharon Pecsi, John Giacomini, Thomas Burdon, James Fann, Gerald Georgette, Dong Yu, Ali Sonel, Marco Zenati, Larry Shears, Lawrence Wei, Kenneth McCurry, Robert Kormos, Jennifer Gabany, Kathleen Ross, Alanna Macioce, Pasala Ravichandran, John Blizzard, Matt Slatter, Howard Song, Karina Dana, Volio Kesic, Mark Ratcliffe, Jon Baker, Timothy Hall, Michael Mann, T Sloane Guy, Elaine Tseng, Mary Jane Wood, Edward Sako, Gregory Freeman, Andrea Carpenter, Daniel Martinez, V Sreenath Reddy, Regina Whitener, Dimitri Novitzky, Jennifer Darter, Jennifer Shippy, Rebecca Reinhard, Pendleton Alexander, Greg Trachiotis, Mary Bloom, Elizabeth Wyman, Frederick L Grover, Susan Kongs, Michael Hampton, John Messenger, Scott J Haugen, Joel A Garcia, Lisa Schade, Krisann Bruton, Marianne Medlin, Brittany Coker, Christine Dalzell, Darlene Kemp, Jeanie Kim, Shirley Lu, Ellen Sterrett, Annette Wiseman, Timothy J O’Leary, Grant D Huang, John S Rumsfeld, John A Spertus, Fred Edwards, Adam Chow, Hao Jian, Teresa Kulas
Abstract
Background: Coronary-artery bypass grafting (CABG) surgery may be performed either with cardiopulmonary bypass (on pump) or without cardiopulmonary bypass (off pump). We report the 5-year clinical outcomes in patients who had been included in the Veterans Affairs trial of on-pump versus off-pump CABG.
Methods: From February 2002 through June 2007, we randomly assigned 2203 patients at 18 medical centers to undergo either on-pump or off-pump CABG, with 1-year assessments completed by May 2008. The two primary 5-year outcomes were death from any cause and a composite outcome of major adverse cardiovascular events, defined as death from any cause, repeat revascularization (CABG or percutaneous coronary intervention), or nonfatal myocardial infarction. Secondary 5-year outcomes included death from cardiac causes, repeat revascularization, and nonfatal myocardial infarction. Primary outcomes were assessed at a P value of 0.05 or less, and secondary outcomes at a P value of 0.01 or less.
Results: The rate of death at 5 years was 15.2% in the off-pump group versus 11.9% in the on-pump group (relative risk, 1.28; 95% confidence interval [CI], 1.03 to 1.58; P=0.02). The rate of major adverse cardiovascular events at 5 years was 31.0% in the off-pump group versus 27.1% in the on-pump group (relative risk, 1.14; 95% CI, 1.00 to 1.30; P=0.046). For the 5-year secondary outcomes, no significant differences were observed: for nonfatal myocardial infarction, the rate was 12.1% in the off-pump group and 9.6% in the on-pump group (P=0.05); for death from cardiac causes, the rate was 6.3% and 5.3%, respectively (P=0.29); for repeat revascularization, the rate was 13.1% and 11.9%, respectively (P=0.39); and for repeat CABG, the rate was 1.4% and 0.5%, respectively (P=0.02).
Conclusions: In this randomized trial, off-pump CABG led to lower rates of 5-year survival and event-free survival than on-pump CABG. (Funded by the Department of Veterans Affairs Office of Research and Development Cooperative Studies Program and others; ROOBY-FS ClinicalTrials.gov number, NCT01924442 .).
Source: PubMed