title: Three-year follow-up in a subset of high-risk patients randomly assigned to off-pump versus on-pump coronary artery bypass surgery: the Best Bypass Surgery trial.
abstract: OBJECTIVE
  To evaluate off-pump versus on-pump coronary artery bypass grafting (CABG) in patients with three-vessel disease and a high-risk operative profile.
  
  
  METHODS
  A randomised clinical trial.
  
  
  METHODS
  Rigshospitalet, University Hospital, Copenhagen, Denmark.
  
  
  METHODS
  341 patients with three-vessel disease and a EuroSCORE of 5 or greater. Main exclusion criteria were previous heart surgery, poor left ventricular function (ejection fraction <30%), or unstable preoperative condition.
  
  
  METHODS
  CABG performed with versus without cardiopulmonary bypass.
  
  
  METHODS
  The primary outcome was a composite of major adverse cardiac and cerebrovascular events (MACCE) including all-cause mortality, acute myocardial infarction, cardiac arrest with successful resuscitation, low cardiac output syndrome/cardiogenic shock, stroke and coronary reintervention.
  
  
  RESULTS
  MACCE occurred in 69 (40%) patients allocated to off-pump versus 54 (33%) patients allocated to on-pump CABG during the median 3.7 years of follow-up (HR 1.22; 95% CI 0.86 to 1.75; p=0.26). All-cause mortality was significantly increased in the off-pump group (24% vs 15%; HR 1.66, 95% CI 1.02 to 2.73; p=0.04), but cardiac-related death was not significantly different (10% vs 7%; HR 1.30, 95% CI 0.64 to 2.66; p=0.47). An insignificant trend towards a reduction in myocardial infarction after off-pump CABG was observed (7% vs 14%; HR 0.53, 95% CI: 0.27 to 1.04; p=0.06).
  
  
  CONCLUSIONS
  No significant difference in the primary outcome of MACCE was found between off-pump and on-pump CABG. However, mortality seemed higher after off-pump CABG.
  
  
  BACKGROUND
  http://clinicaltrials.gov/number, NCT00120991.
authors.affiliation: Department of Cardio-Thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark. chm@ctu.rh.dk
authors.forename: Christian H
authors.initials: CH
authors.lastname: Møller
authors.forename: Mario J
authors.initials: MJ
authors.lastname: Perko
authors.forename: Jens T
authors.initials: JT
authors.lastname: Lund
authors.forename: Lars W
authors.initials: LW
authors.lastname: Andersen
authors.forename: Henning
authors.initials: H
authors.lastname: Kelbæk
authors.forename: Jan K
authors.initials: JK
authors.lastname: Madsen
authors.forename: Per
authors.initials: P
authors.lastname: Winkel
authors.forename: Christian
authors.initials: C
authors.lastname: Gluud
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Steinbrüchel
mesh_terms: D000368:Aged; D002303:Cardiac Output, Low / Q000401:mortality; D001026:Coronary Artery Bypass / Q000401:mortality*; D047549:Coronary Artery Bypass, Off-Pump / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D012086:Reoperation; D012307:Risk Factors; D020521:Stroke / Q000401:mortality; D016896:Treatment Outcome