On pump versus off pump coronary artery bypass grafting in patients with end-stage renal disease and coronary artery disease - A nation-wide, propensity score matched database analyses.
OBJECTIVE
The usage of on or off cardiopulmonary bypass in patients with coronary artery disease receiving coronary artery bypass grafting (CABG) surgery had been debated and had not yet been investigated thoroughly in patients with end-stage renal disease (ESRD). We aimed to study cardiovascular outcomes and total mortality in these patients by using our National Health Insurance (NHI) database.


METHODS
By using our NHI ESRD claim database, we searched ESRD patients aged more than 18years, who received CABG and divided them into on pump and off pump groups. Baseline characteristics and underlying comorbidities were identified from the database. Propensity score (PS) method was used to match all the potential confounders between patients. Outcomes including mortality, myocardial infarction, stroke and repeat revascularization within 30days, 1year and whole follow-up period were also obtained.


RESULTS
A total of 134,410 ESRD patients were identified in the database. We included 341 patients and 543 patients who received off pump and on pump CABG respectively. The hazard ratios of different outcomes at 30days, 1year and a median of 745days after CABG did not show significant different between on, or off pump groups before and after PS match.


CONCLUSIONS
ESRD patients with CAD undergoing either on pump or off pump CABG surgery showed similar outcomes in 30days, 1year and whole follow-up period.
Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Douliou, Taiwan.
Jien-Jiun
JJ
Chen
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Lian-Yu
LY
Lin
Department for Traditional Chinese Medicine, Chang Gung Memorial Hospital Chia-Yi, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan.
Yao-Hsu
YH
Yang
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Juey-Jen
JJ
Hwang
Department for Traditional Chinese Medicine, Chang Gung Memorial Hospital Chia-Yi, Taiwan.
Pau-Chung
PC
Chen
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Jiunn-Lee
JL
Lin
Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: chinaihsin@gmail.com.
Nai-Hsin
NH
Chi
D000367:Age Factors; D000368:Aged; D002315:Cardiopulmonary Bypass / Q000379:methods / Q000401:mortality*; D016022:Case-Control Studies; D015897:Comorbidity; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods* / Q000401:mortality; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D057216:Propensity Score; D018570:Risk Assessment; D012737:Sex Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013624:Taiwan; D016896:Treatment Outcome
Coronary artery bypass grafting; Coronary artery disease; End-stage renal disease; Off pump; On pump