title: On or off pump coronary bypass? Insight from matched and principal component analyses of 8779 operations.
abstract: OBJECTIVE
  The aim of this paper was to compare the clinical impact of the different myocardial protection strategies in coronary artery bypass grafting (CABG) patients to facilitate decision-making for use of on- or off-pump technique.
  
  
  METHODS
  Prospectively collected data for primary CABG patients between April 1, 1996 and December 30, 2010 (N.=8779) were analyzed. Early adverse cardiac and cerebrovascular events (ACCE) and late survival were compared between on-pump; cardioplegia (CPA, N.=3862, 44%), cross-clamp fibrillation (XCF, N.=3751, 43%), and off-pump (N.=1166, 13%) myocardial protection. Second, clinical profiling for the risk of ACCE with each strategy was performed using principal component analysis. Finally, a 1:1 matched cohort comparison of 1055 patients was done.
  
  
  RESULTS
  There were vast differences in baseline characteristics between groups. Significantly fewer grafts per patient were constructed using off-pump. There were no remarkable differences in operative mortality and 10-year survival rates between the groups after restrictive matching. Principal component analysis identified high risk profiles; factor 1 (ejection fraction 30-50%, prior myocardial infarction, non-elective operation), and factors 4 (hypertension, hypercholesterolemia, Body Mass Index >30 kg/m2) and 5 (female, octogenarian, left main stem disease) to be strongly associated with ACCE after on-pump CABG while lower risk profiles; factors 5 and 6 (extracardiac arteriopathy, prior stroke) were associated with ACCE after off-pump CABG.
  
  
  CONCLUSIONS
  Comparatively, on-pump techniques were associated with greater risk of adverse events in "high risk" patients defined by clinical characteristics, while off-pump was associated with increased risk of adverse events in "low risk" patients.
authors.affiliation: Lancashire Cardiac Centre, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, UK - dngaage@yahoo.com.
authors.forename: D L
authors.initials: DL
authors.lastname: Ngaage
authors.forename: S
authors.initials: S
authors.lastname: Rogers
authors.forename: A
authors.initials: A
authors.lastname: Tang
authors.forename: F
authors.initials: F
authors.lastname: Sogliani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality; D025341:Principal Component Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome