Abstract 16228: Coronary Artery Bypass Grafting in Patients With End-Stage Renal Disease: The Impact of On-Pump vs. Off-Pump Strategies
Purpose: The optimal surgical strategy during coronary artery bypass grafting (CABG) in patients with end-stage renal disease (ESRD) remains controversial.
Methods: We evaluated consecutive 153 patients with ESRD (aged 62.5±9.2 years, 117 males) undergoing elective isolated CABG (on-pump, n=70; off-pump, n=83) from 1997 through 2012. The rates of adverse outcomes were compared with the use of propensity scores and inverse-probability-weighting to adjust treatment selection bias.
Results: 30-day mortality rate was 5.2% (n=8). During follow-up (100%, 635.3 patient-years), 43 patients experienced major adverse cardiovascular events (MACE; myocardial infarction, repeat revascularization, stroke and hospitalization for cardiovascular causes) and 80 patients died. Overall survival and MACE-free survival rates at 5 years were 58.3±4.4% and 53.3±4.4%, respectively. After adjustment, patients undergoing on-pump CABG tended to have higher risks of early mortality compared with those undergoing off-pump CABG: relative risk of 30-day, 60-day and 90-day mortality of 3.27 (95% CI, 0.64-16.7; P=0.15), 4.11 (95% CI, 0.84-20.1;P=0.081) and 3.62 (95% CI, 0.97-13.5; P=0.055), respectively. During the overall study period, however, both groups showed similar risks of death (hazard ratio [HR], 0.91; 95% CI, 0.57-1.47; P=0.71), and the composite of death and MACE (HR, 1.00; 95% CI 0.66-1.53; P=0.99).
Conclusions: The risk of early mortality tended to be reduced by off pump techniques; however, this benefit was not translated into long-term clinical improvements in patients with ESRD. These findings indicate that although the early outcomes can be improved by off-pump CABG, overall long-term outcomes are affected more by patients’ innate co-morbidities rather than the surgical strategies in this high risk cohort.
- © 2013 by American Heart Association, Inc.