Abstract
Background: Off-pump coronary artery bypass grafting (CABG) negates the requirement for extracorporeal circulation used with the traditional on-pump approach. However, off-pump CABG is technically more challenging and may theoretically lead to less complete revascularisation. Recent data suggests a prognostic benefit for traditional on-pump CABG, but the mechanism for this remains unclear. We hypothesised that the inferior outcomes with off-pump CABG could be driven by the need for repeat revascularisation, with this benefit only becoming clear at long-term follow-up. We therefore evaluated short, medium and long-term outcomes of patients undergoing revascularisation with on vs. off-pump CABG. Methods: Electronic databases were searched to identify suitable randomised controlled trials enrolling ≥100 patients in each arm. Clinical outcomes were extracted at 30-days, 12-months or >4 years. The primary outcome was long-term all-cause death, while secondary outcomes included 30-day, 12-month and >4-year cardiac death, stroke, myocardial infarction or revascularisation. Results: Thirteen studies comprising 13,234 patients were included. Off-pump CABG was associated with an increased risk of all-cause death (Odds Ratio (OR) 1.18, 95% confidence interval (CI) 1.02–1.32, p = 0.01) and repeat bypass surgery (OR 2.57, 95%CI 1.23–5.39, p = 0.01) at long-term follow-up. A significant, increased requirement for revascularisation in off-pump was seen at 12-month follow-up (OR 1.59, 95%CI 1.09–2.33, p = 0.02). No differences were noted between groups at 30-days, 12-months and >4 years for myocardial infarction or stroke. Conclusions: Off-pump CABG is associated with significantly higher rates of all-cause mortality rate at long-term follow-up. These outcomes demonstrate a temporal relationship that may be driven by a greater requirement for repeat revascularisation at 1- and 5-year follow-up. Trial registration: CRD42018102019.
| Original language | English |
|---|---|
| Number of pages | 7 |
| Journal | Heart Lung and Circulation |
| DOIs | |
| Publication status | Accepted/In press - 1 Jan 2019 |
Keywords
- Coronary artery bypass grafting
- Meta-analysis
- Mortality
- Off-pump
- On-pump
Cite this
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Off- vs. On-Pump Coronary Artery Bypass Grafting Long-Term Survival is Driven by Incompleteness of Revascularisation. / Thakur, Udit; Nerlekar, Nitesh; Muthalaly, Rahul G.; Comella, Andrea; Wong, Nathan C.; Cameron, James D.; Harper, Richard W.; Smith, Julian A.; Brown, Adam J.
In: Heart Lung and Circulation, 01.01.2019.Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - Off- vs. On-Pump Coronary Artery Bypass Grafting Long-Term Survival is Driven by Incompleteness of Revascularisation
AU - Thakur, Udit
AU - Nerlekar, Nitesh
AU - Muthalaly, Rahul G.
AU - Comella, Andrea
AU - Wong, Nathan C.
AU - Cameron, James D.
AU - Harper, Richard W.
AU - Smith, Julian A.
AU - Brown, Adam J.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Background: Off-pump coronary artery bypass grafting (CABG) negates the requirement for extracorporeal circulation used with the traditional on-pump approach. However, off-pump CABG is technically more challenging and may theoretically lead to less complete revascularisation. Recent data suggests a prognostic benefit for traditional on-pump CABG, but the mechanism for this remains unclear. We hypothesised that the inferior outcomes with off-pump CABG could be driven by the need for repeat revascularisation, with this benefit only becoming clear at long-term follow-up. We therefore evaluated short, medium and long-term outcomes of patients undergoing revascularisation with on vs. off-pump CABG. Methods: Electronic databases were searched to identify suitable randomised controlled trials enrolling ≥100 patients in each arm. Clinical outcomes were extracted at 30-days, 12-months or >4 years. The primary outcome was long-term all-cause death, while secondary outcomes included 30-day, 12-month and >4-year cardiac death, stroke, myocardial infarction or revascularisation. Results: Thirteen studies comprising 13,234 patients were included. Off-pump CABG was associated with an increased risk of all-cause death (Odds Ratio (OR) 1.18, 95% confidence interval (CI) 1.02–1.32, p = 0.01) and repeat bypass surgery (OR 2.57, 95%CI 1.23–5.39, p = 0.01) at long-term follow-up. A significant, increased requirement for revascularisation in off-pump was seen at 12-month follow-up (OR 1.59, 95%CI 1.09–2.33, p = 0.02). No differences were noted between groups at 30-days, 12-months and >4 years for myocardial infarction or stroke. Conclusions: Off-pump CABG is associated with significantly higher rates of all-cause mortality rate at long-term follow-up. These outcomes demonstrate a temporal relationship that may be driven by a greater requirement for repeat revascularisation at 1- and 5-year follow-up. Trial registration: CRD42018102019.
AB - Background: Off-pump coronary artery bypass grafting (CABG) negates the requirement for extracorporeal circulation used with the traditional on-pump approach. However, off-pump CABG is technically more challenging and may theoretically lead to less complete revascularisation. Recent data suggests a prognostic benefit for traditional on-pump CABG, but the mechanism for this remains unclear. We hypothesised that the inferior outcomes with off-pump CABG could be driven by the need for repeat revascularisation, with this benefit only becoming clear at long-term follow-up. We therefore evaluated short, medium and long-term outcomes of patients undergoing revascularisation with on vs. off-pump CABG. Methods: Electronic databases were searched to identify suitable randomised controlled trials enrolling ≥100 patients in each arm. Clinical outcomes were extracted at 30-days, 12-months or >4 years. The primary outcome was long-term all-cause death, while secondary outcomes included 30-day, 12-month and >4-year cardiac death, stroke, myocardial infarction or revascularisation. Results: Thirteen studies comprising 13,234 patients were included. Off-pump CABG was associated with an increased risk of all-cause death (Odds Ratio (OR) 1.18, 95% confidence interval (CI) 1.02–1.32, p = 0.01) and repeat bypass surgery (OR 2.57, 95%CI 1.23–5.39, p = 0.01) at long-term follow-up. A significant, increased requirement for revascularisation in off-pump was seen at 12-month follow-up (OR 1.59, 95%CI 1.09–2.33, p = 0.02). No differences were noted between groups at 30-days, 12-months and >4 years for myocardial infarction or stroke. Conclusions: Off-pump CABG is associated with significantly higher rates of all-cause mortality rate at long-term follow-up. These outcomes demonstrate a temporal relationship that may be driven by a greater requirement for repeat revascularisation at 1- and 5-year follow-up. Trial registration: CRD42018102019.
KW - Coronary artery bypass grafting
KW - Meta-analysis
KW - Mortality
KW - Off-pump
KW - On-pump
UR - http://www.scopus.com/inward/record.url?scp=85060333880&partnerID=8YFLogxK
U2 - 10.1016/j.hlc.2018.11.019
DO - 10.1016/j.hlc.2018.11.019
M3 - Article
AN - SCOPUS:85060333880
JO - Heart Lung and Circulation
JF - Heart Lung and Circulation
SN - 1443-9506
ER -