Abstract 17960: Off-Pump Coronary Artery Bypass Grafting Confers a Prognostic Benefit Compared to Percutaneous Coronary Intervention in Patients With Poor Left Ventricular Function: A Single Centre 10-Year Experience
Hypothesis: The benefits of ‘off-pump’ coronary artery bypass grafting (OPCABG) remain controversial. The ‘gold standard’ for surgical coronary revascularization remains ‘on-pump’ CABG. In selected patient groups there may be a long term prognostic benefit of OPCABG. We hypothesize that in an OPCABG centre, patients with poor left ventricular function (EF<35%) may benefit both in terms of survival and freedom from MACE compared with CABG and percutaneous coronary intervention (PCI).
Methods: We retrospectively analysed patients between 2005-2015 who underwent coronary revascularisation either by PCI or CABG. Time-related events were described using Kaplan-Meier estimates and compared by Log-rank test. Cox proportional hazards regression analysis was used to evaluate predictive risk factors.
Results: Of a total of 529 patients with EF < 35%, 315 underwent PCI and 214 underwent isolated CABG: 120 patients off-pump, 94 patients on-pump. Of these,185 patients had previous revascularization (any type CABG/PCI). Patients were matched by age 69.13 ± 11.67 (PCI) vs 66.99 ± 10.05 (p=0.084), CCS Class 2.24 ± 1.38 (PCI) vs 2.44 ± 1.27 (p=0.281) and NYHA Class 2.37 ± 0.99 (PCI) vs 2.54 ± 0.91 (p=0.052). Figure 1 shows a significantly higher survival rate in the OPCABG group as compared with CABG and PCI groups. In addition, for patients with EF<35%, CABG performed ‘off- pump’ compared to ‘on-pump’ provides superior freedom from post-operative MACE (Figure2).
Conclusions: As expected, the long-term mortality for patients with poor LV function is relatively high. The survival rate is significantly higher for patients with poor LV function having CABG versus PCI (50% vs 36% at 10 years).
- Coronary artery bypass grafting (CABG)
- Coronary interventions
- Percutaneous coronary intervention (PCI)
- Heart failure, adult
- Myocardial revascularization
Author Disclosures: I. Cummings: None. G. Lucchese: None. M. Husain: None. B. Iqbal: None. S. Raja: None.
- © 2016 by American Heart Association, Inc.