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Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting

OPEN The New England journal of medicine | 25 Oct 2016

A Lamy, PJ Devereaux, D Prabhakaran, DP Taggart, S Hu, Z Straka, LS Piegas, A Avezum, AR Akar, F Lanas Zanetti, AR Jain, N Noiseux, C Padmanabhan, JC Bahamondes, RJ Novick, L Tao, PA Olavegogeascoechea, B Airan, TA Sulling, RP Whitlock, Y Ou, P Gao, S Pettit and S Yusuf
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 .).
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Concepts
Artery, Hypertension, Percutaneous coronary intervention, Angina pectoris, Coronary artery disease, Atherosclerosis, Coronary artery bypass surgery, Myocardial infarction
MeSH headings
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