Equivalent midterm outcomes after off-pump and on-pump coronary surgery.
OBJECTIVE
Multiple reports demonstrate that off-pump surgery reduces the early morbidity associated with coronary artery bypass grafting. To determine if there are any differences in later outcomes, we compared midterm results of propensity-matched patients who underwent off- and on-pump coronary artery bypass grafting.


METHODS
From January 1997 to July 2000, 481 patients underwent off-pump coronary artery bypass grafting and 3231 underwent on-pump coronary artery bypass grafting. Propensity matching was used to match 406 patients from each group. Previously, the propensity-matched off-pump patients were found to have had significantly fewer bypass grafts. These 812 patients were followed for time-related events, including death, myocardial infarction, percutaneous coronary intervention, coronary reoperation, and the combined end point of all-cause mortality, myocardial infarction, and all coronary reintervention. Follow-up was 95% complete.


RESULTS
At 4 years, survival was 87.5% after off-pump and 91.2% after on-pump coronary artery bypass grafting (P =.2); freedom from myocardial infarction was 92.6% and 95.7% (P =.7), respectively; freedom from percutaneous coronary intervention was 94.3% and 95.5% (P =.9), respectively; freedom from coronary reoperation was 98.1% and 99.0% (P =.4), respectively; and freedom from the combined end point of all-cause mortality, myocardial infarction, and coronary reintervention was 75.2% and 82.9% (P =.14), respectively.


CONCLUSIONS
Off-pump and on-pump coronary artery bypass grafting results in equivalent midterm outcomes. Fewer bypass grafts in the off-pump patients did not decrease survival or increase ischemic events at 4 years.
Sabik
Joseph F
JF
Department of Thoracic Surgery, The Cleveland Clinic Foundation, Ohio 44195, USA. sabikj@ccf.org
Blackstone
Eugene H
EH
Lytle
Bruce W
BW
Houghtaling
Penny L
PL
Gillinov
A Marc
AM
Cosgrove
Delos M
DM
D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D023921:Coronary Stenosis / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000453:epidemiology; D006084:Graft Rejection; D006085:Graft Survival; D006355:Heart-Lung Machine; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011336:Probability; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome