Abstract 15329: Does Off-pump Coronary Artery Bypass Grafting (CABG) Avoid Postoperative Stroke Comparable To Percutaneous Coronary Intervention (PCI) ?
Background: According to several studies comparing the outcomes of PCI with CABG, the incidence of postoperative myocardial infarction is lower after CABG; however, that of stroke is higher than PCI because cardiopulmonary bypass causes cerebrovascular complications; however, an increasing number of off-pump CABG (OPCAB) may influence those outcomes.
Methods and Results: Between 2000 and 2002, a total of 9877 Japanese patients undergoing first PCI or CABG were enrolled in the CREDO-Kyoto Registry. Among them patients with multivessel and/or left main disease were included. There were 3877 patients undergoing PCI, 1381 on-pump CABG (ONCAB), and 1069 OPCAB. Median follow-up was 3.5 years. (maximum 6.8 years). <In-hospital outcomes> In-hospital mortality after ONCAB was higher than OPCAB (Odds ratio=2.97, p<0.01), but similar between PCI and OPCAB (0.79, p>0.99). The incidence of stroke after ONCAB was higher (3.44, p<0.01), but that after PCI was lower (0.19, p=0.01) as compared with OPCAB. Significant risk factors for in-hospital stroke were dialysis (OR=4.80, p=0.03), history of stroke (4.26, p<0.01), and chronic kidney disease (CKD, 2.42, p=0.02). <Follow-up outcomes> Follow-up mortality (e.g. after discharge) was similar between ON- and OPCAB (hazard ratio [95% CI]; 1.00 [0.74–1.33], p>0.99), however, the mortality was higher after PCI than OPCAB (1.49 [1.15–1.94], p<0.01). There was no difference in the incidence stroke during the follow-up period between OPCAB and ONCAB (1.36 [0.95–1.96], p=0.20) or PCI (1.05 [0.74–1.51], p>0.99). Significant risk factors for stroke during follow-up were dialysis (2.87, [1.70–4.83], p<0.01), atrial fibrillation (2.16, [1.51–3.08], p<0.01), history of stroke (2.11 [1.61–2.73], p<001), CKD (1.43 [1.07–1.90], p=0.01), and diabetes (1.28 [1.00–1.63], p=0.049).
Conclusions: The incidence of in-hospital stroke after OPCAB is lower than ONCAB, but still has been higher than PCI. During the follow-up, however, the incidence of stroke was similar between OPCAB and PCI. Furthermore, follow-up mortality is lower after CABG than PCI. In conclusion, prevention of perioperative stroke after OPCAB, particularly in patients with dialysis or history of stroke, improves overall outcomes of CABG.
- © 2010 by American Heart Association, Inc.