title: Chronic obstructive pulmonary disease impact upon outcomes: the veterans affairs randomized on/off bypass trial.
abstract: BACKGROUND
  Patients with chronic obstructive pulmonary disease (COPD) are at inherent risk for higher rates of adverse events after coronary artery bypass graft surgery (CABG). As compared with on-pump CABG (ONCAB), it has been suggested that beating heart or off-pump CABG (OPCAB) may differentially benefit high-risk COPD patients.
  
  
  METHODS
  Intraoperative, 30-day and 1-year outcomes were compared for COPD patients randomized to OPCAB (n = 220) versus ONCAB (n = 238) within the Veterans Affairs' Randomized On/Off Bypass (ROOBY) trial. As COPD patients may more likely incur adverse post-CABG outcomes, a propensity analysis was performed comparing all ROOBY patients with COPD (n = 458) versus those without COPD (n = 1,745).
  
  
  RESULTS
  For COPD patients, the baseline characteristics were similar between the 2 revascularization approaches. In these patients, the intraoperative complication rate was higher with OPCAB than ONCAB (21.9% vs 10.1%, respectively; p < 0.001), but there were no significant differences in the 30-day (7.3% vs 7.6%, p = 1.00) or 1-year composite outcome rates (9.5% vs 7.1%, p = 0.39) between the groups. Comparing the COPD patients with propensity-matched non-COPD patients, there was no difference in 1-year major adverse cardiovascular events (including the 1-year composite major adverse cardiac events (MACE) outcome, as well as the individual MACE outcomes for all cause death, acute myocardial infarction, or repeat revascularization).
  
  
  CONCLUSIONS
  In COPD patients, there were more intraoperative complications and no differences in 30-day or 1-year outcomes with OPCAB as compared with ONCAB. Similar to patients without COPD, there was no benefit to using an OPCAB approach in COPD patients.
authors.affiliation: Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin; Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: halmassi@mcw.edu.
authors.forename: G Hossein
authors.initials: GH
authors.lastname: Almassi
authors.affiliation: Northport Veterans Affairs Medical Center, Northport, New York; Eastern Colorado Healthcare System, Department of Veterans Affairs, Denver, Colorado.
authors.forename: A Laurie
authors.initials: AL
authors.lastname: Shroyer
authors.affiliation: Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Maryland.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Collins
authors.affiliation: Eastern Colorado Healthcare System, Department of Veterans Affairs, Denver, Colorado; University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Brack
authors.initials: B
authors.lastname: Hattler
authors.affiliation: Northport Veterans Affairs Medical Center, Northport, New York.
authors.forename: Muath
authors.initials: M
authors.lastname: Bishawi
authors.affiliation: Eastern Colorado Healthcare System, Department of Veterans Affairs, Denver, Colorado.
authors.forename: Janet H
authors.initials: JH
authors.lastname: Baltz
authors.affiliation: Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, California.
authors.forename: Ramin
authors.initials: R
authors.lastname: Ebrahimi
authors.affiliation: Eastern Colorado Healthcare System, Department of Veterans Affairs, Denver, Colorado; University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Grover
mesh_terms: D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications* / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
keywords: 23