Abstract 11210: Long-Term Survival After Coronary Artery Bypass Grafting: On-Pump versus Off-Pump Strategies
Background: The influence of cardiopulmonary bypass strategies during coronary artery bypass grafting (CABG) on long-term survival has not been evaluated in a reasonably sized cohort.
Methods: We evaluated long-term survival data in 5203 patients (aged 62.9±9.1 years, 1340 females) who underwent elective isolated CABG from 1989 through 2012. Long-term survival was compared with the use of propensity scores and inverse-probability-weighting to adjust treatment selection bias.
Results: 2870 patients (55.2%) underwent on-pump CABG whereas 2333 patients (44.8%) underwent off-pump CABG. Patients undergoing on-pump CABG had higher number of distal anastomosis than those undergoing off-pump CABG (3.7±1.2 vs. 3.0±1.1, P<0.001). Survival data were complete in 5167 patients (99.3%) with a median follow-up duration of 6.4 years (inter-quartile range, 3.7-10.5 years). During follow-up, 1181 patients (22.7%) died. After adjustment, patients undergoing off-pump CABG were at a higher risk of death (HR, 1.44; 95% CI, 1.16-1.80; P=0.003) compared with those undergoing on-pump CABG (Figure). The increased risk of death by off-pump CABG was identified even after further adjustments with following grafting strategies: number of distal anastomosis (HR, 1.40; 95% CI, 1.19-1.66; P<0.001), and the use of bilateral mammary arteries (HR, 1.47; 95% CI, 1.25-1.73; P<0.001) or “total arterial revascularization” (HR, 1.50; 95% CI, 1.26-1.77; P<0.001). In subgroup analyses, higher risks of death were associated with the off-pump CABG compared to on-pump CABG in most risk subgroups (stratified by age, diabeties, coronary anatomy, left ventricular function and renal function).
Conclusion: In patients undergoing elective isolated CABG, on-pump strategy conferred a long-term survival advantage compared with off-pump strategy. These findings are pending the verification by follow-up results from large-scale clinical trials.
- © 2013 by American Heart Association, Inc.