Abstract 13335: Benefits of Off-Pump Coronary Artery Bypass Grafting in High-Risk Patients: A Propensity-Score Analysis
Background: Benefits of off-pump CABG (OPCAB) compared with conventional on-pump CABG (CCAB) still has been controversial. However, it is important to investigate which patient subgroups may benefit more from OPCAB rather than CCAB.
Methods and Results: Among the patients undergoing first PCI or CABG enrolled in the CREDO-Kyoto Registry (a registry of first-time PCI and CABG patients in Japan), 2468 patients undergoing CABG were entered into the study (67 ± 9 y.o.). Predicted risk of operative mortality (PROM) of each patient was calculated by logistic EuroSCORE. Patients were divided into tertile based on their PROM. Mortality rates and the incidences of cardiovascular events were compared between CCAB and OPCAB within each PROM tertile using propensity-score analysis. (Table) A total of 1376 patients received CCAB and 1092 did OPCAB. Observed 30-day mortality in whole population was similar between CCAB and OPCAB (odds ratio [95% confidence interval]: 1.18 [0.93-1.51], p=0.17). Observed 30-day mortality tended to be higher after CCAB in each tertile, particularly in high risk one (2.47 [1.00-6.10]. p=0.05). Observed 30-day incidence of myocardial infarction was similar regardless of the PROM range. In the high risk tertile, 30-day incidence of myocardial infarction was similar between CCAB and OPCAB (0.89 [0.31-2.51], p=0.82). On the contrary, observed 30-day incidence of stroke was similar in low or moderate risk tertile; however, that in high risk tertile after CCAB was far higher than OPCAB (13.2 [3.04-57.0], p<0.01). Observed 30-day incidence of composite cardiovascular event (cardiovascular death/myocardial infarction, or stroke) was also similar in low or moderate risk tertile, but, that after CCAB was higher in high risk tertile (3.02 [1.62-5.62], p<0.01).
Conclusions: OPCAB is associated with lower operative mortality and stroke rate than CCAB especially for higher risk patients estimated by EuroSCORE. This benefit increases with increasing PROM.
- © 2011 by American Heart Association, Inc.