On-pump, off-pump CABG have similar long-term outcomes
After five years of follow-up, patients with coronary artery disease had similar rates of the composite outcome of death, stroke, MI, renal failure or repeat revascularization whether they underwent off-pump or on-pump CABG, according to a randomized trial.
Lead researcher André Lamy, MD, of McMaster University in Hamilton, Ontario, Canada, and colleagues published their results online in the New England Journal of Medicine on Oct. 23. The findings were also presented at the Canadian Cardiovascular Congress in Montreal.
The researchers defined on-pump CABG as performing the procedure with the use of a cardiopulmonary bypass and off-pump CABG as performing the procedure on a beating heart.
In this trial, known as CORONARY (CABG Off or On Pump Revascularization Study), the researchers enrolled 4,752 patients at 79 hospitals in 19 countries who required isolated CABG with median sternotomy. From November 2006 through October 2011, they randomized patients in a 1:1 ratio to undergo off-pump or on-pump CABG.
After a mean follow-up period of 4.8 years, a composite outcome event occurred in 23.1 percent of patients in the off-pump group and 23.6 percent of patients in the on-pump group. The composite outcome was death, stroke, MI, renal failure or repeat coronary revascularization.
The groups also had similar rates of each of the composite outcome endpoints. The rates of repeat revascularization were 2.8 percent in the off-pump group and 2.3 percent in the on-pump group.
During the trial, the mean cost per patient was $15,107 in the off-pump group and $14,992 in the on-pump group. The difference was not statistically significant.
For both groups, the quality of life declined slightly after hospital discharge, but it increased sharply by 30 days post-discharge and continued throughout the trial. The rates of repeat coronary angiography and recurrent angina were also similar between the groups.
“Our trial emphasizes the importance of long-term follow-up in surgical trials and indicates that new surgical techniques should be subject to rigorous comparative and large randomized trials before they are adopted widely in practice,” the researchers wrote. “Our trial results indicate that both procedures are equally effective and safe.”
Executive Editor
Tim Casey joined TriMed Media Group in 2015 as Executive Editor. For the previous four years, he worked as an editor and writer for HMP Communications, primarily focused on covering managed care issues and reporting from medical and health care conferences. He was also a staff reporter at the Sacramento Bee for more than four years covering professional, college and high school sports. He earned his undergraduate degree in psychology from the University of Notre Dame and his MBA degree from Georgetown University.