Coronary Artery Revascularization (CARE) registry: an observational study of on-pump and off-pump coronary artery revascularization.
BACKGROUND
The Coronary Artery Revascularization (CARE) study is a multicenter observational registry of coronary revascularization by percutaneous and surgical techniques. As a substudy of this registry, we analyzed the current practice and outcomes of on-pump and off-pump coronary artery bypass graft (CABG) surgery.


METHODS
Procedural and outcomes data were prospectively collected for all patients undergoing isolated CABG in eight community-based hospitals in the HCA Hospital System between February 1 and July 31, 2004. Twelve-month follow-up was obtained by patient contact, phone, questionnaire, and the National Death Index.


RESULTS
Isolated coronary artery revascularization procedures were done in 1251 patients, with 12-month follow-up data available on 1149 (91.8%); 654 patients (52.3%) were operated on-pump and 597 (47.7%) had off-pump procedures. On-pump versus off-pump results were mean number of grafts, 3.4 +/- 1 versus 2.9 +/- 1.2 (p < 0.001); operative mortality, 1.7% versus 1.7% (p = 1.00); permanent stroke, 0.9% versus 0.7% (p = 0.51); reoperation for bleeding, 2.6% versus 1.0% (p = 0.037); prolonged ventilation, 10.0% versus 3.4% (p < 0.001); atrial fibrillation, 23.8% versus 14.9% (p < 0.001); need for transfusion, 51.0% versus 34.9% (p < 0.001); intensive care unit length of stay, 68.1 +/- 97.0 hours versus 59.3 +/- 109.4 hours (p = 0.16); and hospital length of stay, 7.5 days versus 6.2 days (p < 0.001). At 12 months, there was no difference in total cardiac mortality on-pump versus off-pump (4.9% versus 4.6%, p = 0.88), myocardial infarction (1.0% versus 0.7%, p = 0.76), need for repeat revascularization (2.8% versus 4.1%, p = 0.70), or total overall major adverse cardiac outcomes (8.7 versus 9.4, p = 0.69).


CONCLUSIONS
Current approaches to coronary revascularization using both on-pump and off-pump techniques at individual surgeon discretion, which varies significantly in the community setting, leads to acceptable outcomes. Although perioperative complications were less off-pump, mortality was the same, both in the perioperative period and at 12 months. Fewer grafts in the off-pump group appeared to be related to disease burden and not incomplete revascularization. Cardiac death, myocardial infarction, and the need for repeat revascularization were equal at 12 months.
Palmer
George
G
Central Florida Regional Hospital, Sanford, Florida, USA.
Herbert
Morley A
MA
Prince
Syma L
SL
Williams
Janet L
JL
Magee
Mitchell J
MJ
Brown
Phillip
P
Katz
Marc
M
Mack
Michael J
MJ
D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000401:mortality; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D009204:Myocardial Revascularization; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D016896:Treatment Outcome