On-Pump Beating Heart Versus Conventional Coronary Artery Bypass Grafting Early After Myocardial Infarction

A Propensity-Score Matched Analysis From the ANZSCTS Database

Michael Z.L. Zhu, Molla M. Huq, Baki M. Billah, Lavinia Tran, Christopher M. Reid, Kapilan Varatharajah, Franklin L. Rosenfeldt

Research output: Contribution to journalArticleResearchpeer-review

1 Citation (Scopus)

Abstract

Background: Coronary artery bypass grafting (CABG) performed early after acute myocardial infarction (AMI) carries a high risk of mortality. By avoiding cardioplegic arrest and aortic cross-clamping, on-pump beating heart CABG (ONBEAT) may benefit patients requiring urgent or emergency revascularisation in the setting of AMI. We evaluated the early and long-term outcomes of ONBEAT versus conventional CABG (ONSTOP) utilising the ANZSCTS National Cardiac Surgery Database. Methods: Between 2001 and 2015, 5,851 patients underwent non-elective on-pump CABG within 7 days of AMI. Of these, 77 patients (1.3%) underwent ONBEAT and 5774 (98.7%) underwent ONSTOP surgery. Propensity-score matching (with a 1:2 matching ratio) was performed for risk adjustment. Survival data were obtained from the National Death Index. Results: Before matching, the unadjusted 30-day mortality was ONBEAT: 9/77 (11.7%) vs. ONSTOP: 256/5,774 (4.4%), p < 0.001. Preoperative factors independently associated with the ONBEAT were: septuagenarian age, peripheral vascular disease, redo surgery, cardiogenic shock, emergency surgery and single-vessel disease. After propensity-score matching, 30-day mortality was similar (ONBEAT: 9/77 (11.7%) vs. ONSTOP: 16/154 (10.4%), p = 0.85), as was the rate of major adverse cardiac and cerebrovascular events (ONBEAT: 17/77 (22.1%) vs. ONSTOP: 38/154 (24.7%), p = 0.84). ONBEAT patients received fewer distal anastomoses and were more likely to have incomplete revascularisation (ONBEAT: 15/77 (19.5%) vs. ONSTOP: 15/154, (9.7%), p = 0.03). Despite this, 12-year survival was comparable (ONBEAT: 64.8% (95% CI 39.4-82.4%) vs. ONSTOP: 63.6% (95% CI 50.5, 74.3%), p = 0.89). Conclusions: ONBEAT can be performed safely in high-risk patients requiring CABG early after AMI with similar short and long-term survival compared to ONSTOP.

Original languageEnglish
Pages (from-to)1267-1276
Number of pages10
JournalHeart Lung and Circulation
Volume28
Issue number8
DOIs
Publication statusPublished - Aug 2019

Keywords

  • Beating-heart
  • Cardiac surgery
  • Coronary artery bypass
  • Myocardial infarction
  • On-pump

Cite this

@article{eec70fc7d9bc46f0a6db4ea2c137e42c,
title = "On-Pump Beating Heart Versus Conventional Coronary Artery Bypass Grafting Early After Myocardial Infarction: A Propensity-Score Matched Analysis From the ANZSCTS Database",
abstract = "Background: Coronary artery bypass grafting (CABG) performed early after acute myocardial infarction (AMI) carries a high risk of mortality. By avoiding cardioplegic arrest and aortic cross-clamping, on-pump beating heart CABG (ONBEAT) may benefit patients requiring urgent or emergency revascularisation in the setting of AMI. We evaluated the early and long-term outcomes of ONBEAT versus conventional CABG (ONSTOP) utilising the ANZSCTS National Cardiac Surgery Database. Methods: Between 2001 and 2015, 5,851 patients underwent non-elective on-pump CABG within 7 days of AMI. Of these, 77 patients (1.3{\%}) underwent ONBEAT and 5774 (98.7{\%}) underwent ONSTOP surgery. Propensity-score matching (with a 1:2 matching ratio) was performed for risk adjustment. Survival data were obtained from the National Death Index. Results: Before matching, the unadjusted 30-day mortality was ONBEAT: 9/77 (11.7{\%}) vs. ONSTOP: 256/5,774 (4.4{\%}), p < 0.001. Preoperative factors independently associated with the ONBEAT were: septuagenarian age, peripheral vascular disease, redo surgery, cardiogenic shock, emergency surgery and single-vessel disease. After propensity-score matching, 30-day mortality was similar (ONBEAT: 9/77 (11.7{\%}) vs. ONSTOP: 16/154 (10.4{\%}), p = 0.85), as was the rate of major adverse cardiac and cerebrovascular events (ONBEAT: 17/77 (22.1{\%}) vs. ONSTOP: 38/154 (24.7{\%}), p = 0.84). ONBEAT patients received fewer distal anastomoses and were more likely to have incomplete revascularisation (ONBEAT: 15/77 (19.5{\%}) vs. ONSTOP: 15/154, (9.7{\%}), p = 0.03). Despite this, 12-year survival was comparable (ONBEAT: 64.8{\%} (95{\%} CI 39.4-82.4{\%}) vs. ONSTOP: 63.6{\%} (95{\%} CI 50.5, 74.3{\%}), p = 0.89). Conclusions: ONBEAT can be performed safely in high-risk patients requiring CABG early after AMI with similar short and long-term survival compared to ONSTOP.",
keywords = "Beating-heart, Cardiac surgery, Coronary artery bypass, Myocardial infarction, On-pump",
author = "Zhu, {Michael Z.L.} and Huq, {Molla M.} and Billah, {Baki M.} and Lavinia Tran and Reid, {Christopher M.} and Kapilan Varatharajah and Rosenfeldt, {Franklin L.}",
year = "2019",
month = "8",
doi = "10.1016/j.hlc.2018.06.1051",
language = "English",
volume = "28",
pages = "1267--1276",
journal = "Heart Lung and Circulation",
issn = "1443-9506",
publisher = "Elsevier",
number = "8",

}

On-Pump Beating Heart Versus Conventional Coronary Artery Bypass Grafting Early After Myocardial Infarction : A Propensity-Score Matched Analysis From the ANZSCTS Database. / Zhu, Michael Z.L.; Huq, Molla M.; Billah, Baki M.; Tran, Lavinia; Reid, Christopher M.; Varatharajah, Kapilan; Rosenfeldt, Franklin L.

In: Heart Lung and Circulation, Vol. 28, No. 8, 08.2019, p. 1267-1276.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - On-Pump Beating Heart Versus Conventional Coronary Artery Bypass Grafting Early After Myocardial Infarction

T2 - A Propensity-Score Matched Analysis From the ANZSCTS Database

AU - Zhu, Michael Z.L.

AU - Huq, Molla M.

AU - Billah, Baki M.

AU - Tran, Lavinia

AU - Reid, Christopher M.

AU - Varatharajah, Kapilan

AU - Rosenfeldt, Franklin L.

PY - 2019/8

Y1 - 2019/8

N2 - Background: Coronary artery bypass grafting (CABG) performed early after acute myocardial infarction (AMI) carries a high risk of mortality. By avoiding cardioplegic arrest and aortic cross-clamping, on-pump beating heart CABG (ONBEAT) may benefit patients requiring urgent or emergency revascularisation in the setting of AMI. We evaluated the early and long-term outcomes of ONBEAT versus conventional CABG (ONSTOP) utilising the ANZSCTS National Cardiac Surgery Database. Methods: Between 2001 and 2015, 5,851 patients underwent non-elective on-pump CABG within 7 days of AMI. Of these, 77 patients (1.3%) underwent ONBEAT and 5774 (98.7%) underwent ONSTOP surgery. Propensity-score matching (with a 1:2 matching ratio) was performed for risk adjustment. Survival data were obtained from the National Death Index. Results: Before matching, the unadjusted 30-day mortality was ONBEAT: 9/77 (11.7%) vs. ONSTOP: 256/5,774 (4.4%), p < 0.001. Preoperative factors independently associated with the ONBEAT were: septuagenarian age, peripheral vascular disease, redo surgery, cardiogenic shock, emergency surgery and single-vessel disease. After propensity-score matching, 30-day mortality was similar (ONBEAT: 9/77 (11.7%) vs. ONSTOP: 16/154 (10.4%), p = 0.85), as was the rate of major adverse cardiac and cerebrovascular events (ONBEAT: 17/77 (22.1%) vs. ONSTOP: 38/154 (24.7%), p = 0.84). ONBEAT patients received fewer distal anastomoses and were more likely to have incomplete revascularisation (ONBEAT: 15/77 (19.5%) vs. ONSTOP: 15/154, (9.7%), p = 0.03). Despite this, 12-year survival was comparable (ONBEAT: 64.8% (95% CI 39.4-82.4%) vs. ONSTOP: 63.6% (95% CI 50.5, 74.3%), p = 0.89). Conclusions: ONBEAT can be performed safely in high-risk patients requiring CABG early after AMI with similar short and long-term survival compared to ONSTOP.

AB - Background: Coronary artery bypass grafting (CABG) performed early after acute myocardial infarction (AMI) carries a high risk of mortality. By avoiding cardioplegic arrest and aortic cross-clamping, on-pump beating heart CABG (ONBEAT) may benefit patients requiring urgent or emergency revascularisation in the setting of AMI. We evaluated the early and long-term outcomes of ONBEAT versus conventional CABG (ONSTOP) utilising the ANZSCTS National Cardiac Surgery Database. Methods: Between 2001 and 2015, 5,851 patients underwent non-elective on-pump CABG within 7 days of AMI. Of these, 77 patients (1.3%) underwent ONBEAT and 5774 (98.7%) underwent ONSTOP surgery. Propensity-score matching (with a 1:2 matching ratio) was performed for risk adjustment. Survival data were obtained from the National Death Index. Results: Before matching, the unadjusted 30-day mortality was ONBEAT: 9/77 (11.7%) vs. ONSTOP: 256/5,774 (4.4%), p < 0.001. Preoperative factors independently associated with the ONBEAT were: septuagenarian age, peripheral vascular disease, redo surgery, cardiogenic shock, emergency surgery and single-vessel disease. After propensity-score matching, 30-day mortality was similar (ONBEAT: 9/77 (11.7%) vs. ONSTOP: 16/154 (10.4%), p = 0.85), as was the rate of major adverse cardiac and cerebrovascular events (ONBEAT: 17/77 (22.1%) vs. ONSTOP: 38/154 (24.7%), p = 0.84). ONBEAT patients received fewer distal anastomoses and were more likely to have incomplete revascularisation (ONBEAT: 15/77 (19.5%) vs. ONSTOP: 15/154, (9.7%), p = 0.03). Despite this, 12-year survival was comparable (ONBEAT: 64.8% (95% CI 39.4-82.4%) vs. ONSTOP: 63.6% (95% CI 50.5, 74.3%), p = 0.89). Conclusions: ONBEAT can be performed safely in high-risk patients requiring CABG early after AMI with similar short and long-term survival compared to ONSTOP.

KW - Beating-heart

KW - Cardiac surgery

KW - Coronary artery bypass

KW - Myocardial infarction

KW - On-pump

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U2 - 10.1016/j.hlc.2018.06.1051

DO - 10.1016/j.hlc.2018.06.1051

M3 - Article

VL - 28

SP - 1267

EP - 1276

JO - Heart Lung and Circulation

JF - Heart Lung and Circulation

SN - 1443-9506

IS - 8

ER -