Off-pump versus on-pump coronary-artery bypass grafting in elderly patients
Anno Diegeler, Jochen Börgermann, Utz Kappert, Martin Breuer, Andreas Böning, Adrian Ursulescu, Ardawan Rastan, David Holzhey, Hendrik Treede, Friedrich-Christian Rieß, Philippe Veeckmann, Amjad Asfoor, Wilko Reents, Michael Zacher, Michael Hilker, GOPCABE Study Group, A Diegeler, M Hilker, A Krian, D Birnbaum, T Fetsch, E Brunn, M Zacher, R H Boedeker, A Diegeler, W Dinstak, O Friesewinkel, S Klügl, W Reents, B Rosada, J Börgermann, J Gummert, K Hakim, L Hornik, N Mirow, K Alexiou, S Brose, U Kappert, K Matschke, K Plötze, S M Tugetkin, M Hilker, R Kobuch, L Rupprecht, C Schmid, T Bossert, M Breuer, T Doenst, G Färber, K Hekmat, A Böning, O Coskun, P Roth, M Albert, A Blehm, U F W Franke, M Maedge, R Nagib, A Ursulescu, F Bakhtiary, A K Funkat, J Garbade, D Holzhey, S Lehmann, A Rastan, H Gulbins, M Ismail, P Marcsek, H Treede, E Cramer, L Hansen, C Lehmann, F C Rieß, J Stripling, S Winkel, M Cakir, R Kiefer, J Loew, F Noak, F Rose, P Veeckman, A Asfoor, A Laczkovics, D Reber, Anno Diegeler, Jochen Börgermann, Utz Kappert, Martin Breuer, Andreas Böning, Adrian Ursulescu, Ardawan Rastan, David Holzhey, Hendrik Treede, Friedrich-Christian Rieß, Philippe Veeckmann, Amjad Asfoor, Wilko Reents, Michael Zacher, Michael Hilker, GOPCABE Study Group, A Diegeler, M Hilker, A Krian, D Birnbaum, T Fetsch, E Brunn, M Zacher, R H Boedeker, A Diegeler, W Dinstak, O Friesewinkel, S Klügl, W Reents, B Rosada, J Börgermann, J Gummert, K Hakim, L Hornik, N Mirow, K Alexiou, S Brose, U Kappert, K Matschke, K Plötze, S M Tugetkin, M Hilker, R Kobuch, L Rupprecht, C Schmid, T Bossert, M Breuer, T Doenst, G Färber, K Hekmat, A Böning, O Coskun, P Roth, M Albert, A Blehm, U F W Franke, M Maedge, R Nagib, A Ursulescu, F Bakhtiary, A K Funkat, J Garbade, D Holzhey, S Lehmann, A Rastan, H Gulbins, M Ismail, P Marcsek, H Treede, E Cramer, L Hansen, C Lehmann, F C Rieß, J Stripling, S Winkel, M Cakir, R Kiefer, J Loew, F Noak, F Rose, P Veeckman, A Asfoor, A Laczkovics, D Reber
Abstract
Background: The benefits of coronary-artery bypass grafting (CABG) without cardiopulmonary bypass in the elderly are still undetermined.
Methods: We randomly assigned patients 75 years of age or older who were scheduled for elective first-time CABG to undergo the procedure either without cardiopulmonary bypass (off-pump CABG) or with it (on-pump CABG). The primary end point was a composite of death, stroke, myocardial infarction, repeat revascularization, or new renal-replacement therapy at 30 days and at 12 months after surgery.
Results: A total of 2539 patients underwent randomization. At 30 days after surgery, there was no significant difference between patients who underwent off-pump surgery and those who underwent on-pump surgery in terms of the composite outcome (7.8% vs. 8.2%; odds ratio, 0.95; 95% confidence interval [CI], 0.71 to 1.28; P=0.74) or four of the components (death, stroke, myocardial infarction, or new renal-replacement therapy). Repeat revascularization occurred more frequently after off-pump CABG than after on-pump CABG (1.3% vs. 0.4%; odds ratio, 2.42; 95% CI, 1.03 to 5.72; P=0.04). At 12 months, there was no significant between-group difference in the composite end point (13.1% vs. 14.0%; hazard ratio, 0.93; 95% CI, 0.76 to 1.16; P=0.48) or in any of the individual components. Similar results were obtained in a per-protocol analysis that excluded the 177 patients who crossed over from the assigned treatment to the other treatment.
Conclusions: In patients 75 years of age or older, there was no significant difference between on-pump and off-pump CABG with regard to the composite outcome of death, stroke, myocardial infarction, repeat revascularization, or new renal-replacement therapy within 30 days and within 12 months after surgery. (Funded by Maquet; GOPCABE ClinicalTrials.gov number, NCT00719667.).
Source: PubMed