title: Off-pump or on-pump coronary-artery bypass grafting at 30 days.
abstract: BACKGROUND
  The relative benefits and risks of performing coronary-artery bypass grafting (CABG) with a beating-heart technique (off-pump CABG), as compared with cardiopulmonary bypass (on-pump CABG), are not clearly established.
  
  
  METHODS
  At 79 centers in 19 countries, we randomly assigned 4752 patients in whom CABG was planned to undergo the procedure off-pump or on-pump. The first coprimary outcome was a composite of death, nonfatal stroke, nonfatal myocardial infarction, or new renal failure requiring dialysis at 30 days after randomization.
  
  
  RESULTS
  There was no significant difference in the rate of the primary composite outcome between off-pump and on-pump CABG (9.8% vs. 10.3%; hazard ratio for the off-pump group, 0.95; 95% confidence interval [CI], 0.79 to 1.14; P=0.59) or in any of its individual components. The use of off-pump CABG, as compared with on-pump CABG, significantly reduced the rates of blood-product transfusion (50.7% vs. 63.3%; relative risk, 0.80; 95% CI, 0.75 to 0.85; P<0.001), reoperation for perioperative bleeding (1.4% vs. 2.4%; relative risk, 0.61; 95% CI, 0.40 to 0.93; P=0.02), acute kidney injury (28.0% vs. 32.1%; relative risk, 0.87; 95% CI, 0.80 to 0.96; P=0.01), and respiratory complications (5.9% vs. 7.5%; relative risk, 0.79; 95% CI, 0.63 to 0.98; P=0.03) but increased the rate of early repeat revascularizations (0.7% vs. 0.2%; hazard ratio, 4.01; 95% CI, 1.34 to 12.0; P=0.01).
  
  
  CONCLUSIONS
  There was no significant difference between off-pump and on-pump CABG with respect to the 30-day rate of death, myocardial infarction, stroke, or renal failure requiring dialysis. The use of off-pump CABG resulted in reduced rates of transfusion, reoperation for perioperative bleeding, respiratory complications, and acute kidney injury but also resulted in an increased risk of early revascularization. (Funded by the Canadian Institutes of Health Research; CORONARY ClinicalTrials.gov number, NCT00463294.).
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada. lamya@mcmaster.ca
authors.forename: André
authors.initials: A
authors.lastname: Lamy
authors.forename: P J
authors.initials: PJ
authors.lastname: Devereaux
authors.forename: Dorairaj
authors.initials: D
authors.lastname: Prabhakaran
authors.forename: David P
authors.initials: DP
authors.lastname: Taggart
authors.forename: Shengshou
authors.initials: S
authors.lastname: Hu
authors.forename: Ernesto
authors.initials: E
authors.lastname: Paolasso
authors.forename: Zbynek
authors.initials: Z
authors.lastname: Straka
authors.forename: Leopoldo S
authors.initials: LS
authors.lastname: Piegas
authors.forename: Ahmet Ruchan
authors.initials: AR
authors.lastname: Akar
authors.forename: Anil R
authors.initials: AR
authors.lastname: Jain
authors.forename: Nicolas
authors.initials: N
authors.lastname: Noiseux
authors.forename: Chandrasekar
authors.initials: C
authors.lastname: Padmanabhan
authors.forename: Juan-Carlos
authors.initials: JC
authors.lastname: Bahamondes
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Novick
authors.forename: Prashant
authors.initials: P
authors.lastname: Vaijyanath
authors.forename: Sukesh
authors.initials: S
authors.lastname: Reddy
authors.forename: Liang
authors.initials: L
authors.lastname: Tao
authors.forename: Pablo A
authors.initials: PA
authors.lastname: Olavegogeascoechea
authors.forename: Balram
authors.initials: B
authors.lastname: Airan
authors.forename: Toomas-Andres
authors.initials: TA
authors.lastname: Sulling
authors.forename: Richard P
authors.initials: RP
authors.lastname: Whitlock
authors.forename: Yongning
authors.initials: Y
authors.lastname: Ou
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ng
authors.forename: Susan
authors.initials: S
authors.lastname: Chrolavicius
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass; D047549:Coronary Artery Bypass, Off-Pump; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D051437:Renal Insufficiency / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D016037:Single-Blind Method; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome