Long-term survival following coronary artery bypass grafting: off-pump versus on-pump strategies.
OBJECTIVE
This study sought to compare long-term survival after off- and on-pump coronary artery bypass grafting (CABG).


BACKGROUND
Although several large-scale clinical trials have compared the surgical outcomes between off- and on-pump CABG, the long-term survival has not been compared between the 2 surgical strategies in a reasonably sized cohort.


METHODS
We evaluated long-term survival data in 5,203 patients (age 62.9 ± 9.1 years, 1,340 females) who underwent elective isolated CABG (off-pump: n = 2,333; on-pump: n = 2,870) from 1989 through 2012. Vital statuses were validated using the Korean National Registry of Vital Statistics. Long-term survival was compared with the use of propensity scores and inverse probability weighting to adjust selection bias.


RESULTS
Patients undergoing on-pump CABG had a higher number of distal anastomoses than those undergoing off-pump CABG (3.7 ± 1.2 vs. 3.0 ± 1.1; p < 0.001). Survival data were complete in 5,167 patients (99.3%), with a median follow-up duration of 6.4 years (interquartile range: 3.7 to 10.5 years; maximum 23.1 years). During follow-up, 1,181 patients (22.7%) died. After adjustment, both groups of patients showed a similar risk of death at 30 days (odds ratio: 0.70; 95% confidence interval [CI]: 0.35 to 1.40; p = 0.31) and up to 1 year (hazard ratio [HR]: 1.11; 95% CI: 0.74 to 1.65; p = 0.62). For overall mortality, however, patients undergoing off-pump CABG were at a significantly higher risk of death (HR: 1.43; 95% CI: 1.19 to 1.71; p < 0.0001) compared with those undergoing on-pump CABG. In subgroup analyses, on-pump CABG conferred survival benefits in most demographic, clinical, and anatomic subgroups compared with off-pump CABG.


CONCLUSIONS
In patients undergoing elective isolated CABG, on-pump strategy conferred a long-term survival advantage compared with off-pump strategy.
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Joon Bum
JB
Kim
Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Seoul, South Korea.
Sung-Cheol
SC
Yun
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Jae Wong
JW
Lim
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Soo Kyung
SK
Hwang
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Sung-Ho
SH
Jung
Department of Thoracic and Cardiovascular Surgery, Seoul Saint Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, South Korea.
Hyun
H
Song
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Cheol Hyun
CH
Chung
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Jae Won
JW
Lee
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. Electronic address: sjchoo@amc.seoul.kr.
Suk Jung
SJ
Choo
D000368:Aged; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000401:mortality / Q000639:trends; D047549:Coronary Artery Bypass, Off-Pump / Q000401:mortality* / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
cardiopulmonary bypass; coronary artery bypass graft surgery; survival