title: Off-pump versus on-pump coronary-artery bypass grafting in elderly patients.
abstract: BACKGROUND
  The benefits of coronary-artery bypass grafting (CABG) without cardiopulmonary bypass in the elderly are still undetermined.
  
  
  METHODS
  We randomly assigned patients 75 years of age or older who were scheduled for elective first-time CABG to undergo the procedure either without cardiopulmonary bypass (off-pump CABG) or with it (on-pump CABG). The primary end point was a composite of death, stroke, myocardial infarction, repeat revascularization, or new renal-replacement therapy at 30 days and at 12 months after surgery.
  
  
  RESULTS
  A total of 2539 patients underwent randomization. At 30 days after surgery, there was no significant difference between patients who underwent off-pump surgery and those who underwent on-pump surgery in terms of the composite outcome (7.8% vs. 8.2%; odds ratio, 0.95; 95% confidence interval [CI], 0.71 to 1.28; P=0.74) or four of the components (death, stroke, myocardial infarction, or new renal-replacement therapy). Repeat revascularization occurred more frequently after off-pump CABG than after on-pump CABG (1.3% vs. 0.4%; odds ratio, 2.42; 95% CI, 1.03 to 5.72; P=0.04). At 12 months, there was no significant between-group difference in the composite end point (13.1% vs. 14.0%; hazard ratio, 0.93; 95% CI, 0.76 to 1.16; P=0.48) or in any of the individual components. Similar results were obtained in a per-protocol analysis that excluded the 177 patients who crossed over from the assigned treatment to the other treatment.
  
  
  CONCLUSIONS
  In patients 75 years of age or older, there was no significant difference between on-pump and off-pump CABG with regard to the composite outcome of death, stroke, myocardial infarction, repeat revascularization, or new renal-replacement therapy within 30 days and within 12 months after surgery. (Funded by Maquet; GOPCABE ClinicalTrials.gov number, NCT00719667.).
authors.affiliation: Herz- und Gefäß-Klinik Bad Neustadt, Bad Neustadt, Germany. cachir@herzchirurgie.de
authors.forename: Anno
authors.initials: A
authors.lastname: Diegeler
authors.forename: Jochen
authors.initials: J
authors.lastname: Börgermann
authors.forename: Utz
authors.initials: U
authors.lastname: Kappert
authors.forename: Martin
authors.initials: M
authors.lastname: Breuer
authors.forename: Andreas
authors.initials: A
authors.lastname: Böning
authors.forename: Adrian
authors.initials: A
authors.lastname: Ursulescu
authors.forename: Ardawan
authors.initials: A
authors.lastname: Rastan
authors.forename: David
authors.initials: D
authors.lastname: Holzhey
authors.forename: Hendrik
authors.initials: H
authors.lastname: Treede
authors.forename: Friedrich-Christian
authors.initials: FC
authors.lastname: Rieß
authors.forename: Philippe
authors.initials: P
authors.lastname: Veeckmann
authors.forename: Amjad
authors.initials: A
authors.lastname: Asfoor
authors.forename: Wilko
authors.initials: W
authors.lastname: Reents
authors.forename: Michael
authors.initials: M
authors.lastname: Zacher
authors.forename: Michael
authors.initials: M
authors.lastname: Hilker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057194:Intention to Treat Analysis; D053208:Kaplan-Meier Estimate; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D011788:Quality of Life; D051437:Renal Insufficiency / Q000209:etiology; D012086:Reoperation / Q000706:statistics & numerical data; D020521:Stroke / Q000209:etiology