Impact of off-pump coronary artery bypass grafting on long-term percutaneous coronary interventions.
OBJECTIVE
The debate regarding the advantages and limitations of off-pump versus on-pump coronary artery bypass grafting (CABG) has yet to be resolved. This study was designed to compare the impact of surgical technique on long-term mortality and subsequent revascularization.


METHODS
The Predicting Long-Term Outcomes After Isolated Coronary Artery Bypass Surgery (PRIORITY) project was designed to evaluate the long-term outcomes of 2 large, prospective multicenter cohort studies on CABG conducted in Italy between 2002 and 2004 and in 2007 and 2008. Clinical data on isolated CABG were compiled from 2 administrative databases.


RESULTS
The study population consisted of 11,021 patients who underwent isolated CABG (27.2% off-pump CABG). Surgical strategy did not affect in-hospital mortality. Multivariate logistic regression demonstrated that on-pump CABG was the only factor that protected from in-hospital percutaneous coronary intervention after surgery (odds ratio, 0.61). Although unadjusted long-term survival was significantly worse for off-pump CABG, adjustment did not confirm off-pump CABG as a risk factor for mortality (hazard ratio, 0.96; 95% confidence interval, 0.87-1.06). The on-pump CABG group had a significantly lower hospitalization for subsequent percutaneous coronary intervention, a finding confirmed even with adjustment for confounding factors (hazard ratio, 0.70; 95% confidence interval, 0.62-0.80; P < .001). Off-pump CABG thus carried a 42% higher risk for subsequent percutaneous coronary intervention than on-pump CABG. The incidence of repeat CABG was similar between groups.


CONCLUSIONS
This study demonstrated that off-pump OPCAB did not affect short- and long-term mortality, but it was a significant risk factor for rehospitalization for percutaneous coronary intervention.
Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy. Electronic address: fabarili@libero.it.
Fabio
F
Barili
National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy.
Stefano
S
Rosato
National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy.
Paola
P
D'Errigo
Unit of Cardiac Surgery and Translational Research, IRCCS Policlinico S. Donato, S. Donato Milanese, Italy.
Alessandro
A
Parolari
Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy.
Danilo
D
Fusco
Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy.
Carlo Alberto
CA
Perucci
Unit of Cardiac Surgery, IRCCS Policlinico S. Donato, University of Milan, Milanese, Italy.
Lorenzo
L
Menicanti
National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy.
Fulvia
F
Seccareccia
D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality; D047549:Coronary Artery Bypass, Off-Pump / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data; D062645:Percutaneous Coronary Intervention / Q000401:mortality / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors
follow-up studies; revascularization; risk factors; surgery