Although several large–scale clinical trials have compared the surgical outcomes between off–pump and on–pump CABG, the long–term survival has not been compared between the two surgical strategies in a reasonably sized cohort. To compare long–term survival after off–pump and on–pump coronary artery bypass grafting (CABG). In patients undergoing elective isolated CABG, on–pump strategy conferred a long–term survival advantage compared with off–pump strategy.
Methods
- Authors evaluated long–term survival data in 5203 patients (aged 62.9±9.1 years, 1340 females) who underwent elective isolated CABG (off–pump, n=2333; on–pump, n=2870) from 1989 through 2012.
- Vital statuses were validated from Korean National Registry of Vital Statistics.
- Long–term survival was compared with the use of propensity scores and inverse–probability–weighting to adjust selection bias.
Results
- Patients undergoing on–pump CABG had higher number of distal anastomoses 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; maximum 23.1 years).
- During follow–up, 1181 patients (22.7%) died.
- After adjustment, both groups of patients showed a similar risk of death at 30–day (odds ratio, 0.70; 95% CI, 0.35–1.40; P=0.31) and up to one year (HR, 1.11; 95% CI, 0.74–1.65; P=0.62).
- For overall mortality, however, patients undergoing off–pump CABG were at a significantly higher risk of death (HR, 1.43; 95% CI 1.19–1.71; P<0.0001) compared with those undergoing on–pump CABG.
- In subgroup analyses, on–pump CABG conferred survival benefits in most demographic, clinical and anatomic subgroups compared with off–pump CABG