CLINICAL PERSPECTIVE

This Article Abstract Full Text (PDF) CME: Take the course for this article: Circulation: September 4, 2007, Volume 116, Number 10 All Versions of this Article: 116/10/1145    most recent CIRCULATIONAHA.106.675595v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hannan, E. L. Articles by Jones, R. H. Search for Related Content PubMed PubMed Citation Articles by Hannan, E. L. Articles by Jones, R. H. Related Collections CV surgery: coronary artery disease Related Article

(Circulation. 2007;116:1145-1152.)
© 2007 American Heart Association, Inc.

Health Services and Outcomes Research

CLINICAL PERSPECTIVE

Off-pump coronary artery bypass graft surgery (OPCAB) has been performed for many years, but its use is increasing in frequency, and it remains an open question whether OPCAB is associated with better outcomes than on-pump coronary artery bypass graft (CABG) surgery. This study examined data for New York State patients who underwent either OPCAB with median sternotomy (13 889 patients) or on-pump CABG surgery (35 941 patients) between 2001 and 2004. Short- and long-term outcomes were compared after adjustment for patient risk factors and after patients were matched on the basis of significant predictors of type of CABG surgery. Findings were that OPCAB had a significantly lower inpatient/30-day mortality rate (adjusted OR 0.81, 95% confidence interval [CI] 0.68 to 0.97), lower rates for 2 perioperative complications (stroke: adjusted OR 0.70, 95% CI 0.57 to 0.86; respiratory failure: adjusted OR 0.80, 95% CI 0.68 to 0.93), and a higher rate of unplanned operation in the same admission (adjusted OR 1.47, 95% CI 1.01 to 2.15). No difference existed in 3-year mortality (hazard ratio 1.08, 95% CI 0.96 to 1.22), but OPCAB patients had significantly higher rates of subsequent revascularization (hazard ratio 1.55, 95% CI 1.33 to 1.80). The 3-year OPCAB and on-pump survival rates for matched patients were 89.4% versus 90.1%, respectively (P=0.20). For freedom from subsequent revascularization, the respective rates were 89.9% versus 93.6% (P<0.0001). In conclusion, OPCAB is associated with lower in-hospital mortality and complication rates than on-pump CABG, but long-term outcomes are comparable except for freedom from revascularization, which favors on-pump CABG.

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This Article Abstract Full Text (PDF) CME: Take the course for this article: Circulation: September 4, 2007, Volume 116, Number 10 All Versions of this Article: 116/10/1145    most recent CIRCULATIONAHA.106.675595v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hannan, E. L. Articles by Jones, R. H. Search for Related Content PubMed PubMed Citation Articles by Hannan, E. L. Articles by Jones, R. H. Related Collections CV surgery: coronary artery disease Related Article