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Off-pump coronary bypass provides reduced mortality and morbidity and equivalent 10-year survival.
Ann Thorac Surg. 2008 Oct; 86(4):1139-46; discussion 1146.AT

Abstract

BACKGROUND

This study compared in-hospital major adverse cardiac events (MACE) and long-term survival after off-pump (OPCAB) vs on-pump (CPB) coronary artery bypass grafting (CABG).

METHODS

Reviewed were 12,812 consecutive isolated CABG patients from 1997 to 2006. A propensity score (PS), including 40 preoperative risk factors, balanced characteristics between OPCAB and CPB groups. Multiple logistic regression models tested whether gender or surgery type, or their interaction, were associated with in-hospital mortality and MACE. A proportional hazards regression model and Kaplan-Meier curves related long-term survival with gender, surgery type, and their interaction, adjusted for PS and age.

RESULTS

OPCAB was associated with a significant reduction in operative mortality (adjusted odds ratio [AOR], 0.68; p = 0.045), stroke (AOR, 0.48; p < 0.001), and MACE (AOR, 0.66; p = 0.018). Female gender was associated with higher rates of death (AOR, 1.93), stroke (AOR, 1.82), myocardial infarction (AOR, 2.19), and MACE (AOR, 1.97; each p < 0.001). Women disproportionately benefited from OPCAB in operative mortality (p = 0.04). Odds of death for women on CPB were higher than for women treated with OPCAB (AOR, 2.07, p = 0.005). Odds of death for men on CPB were not significantly higher than for men treated with OPCAB (AOR, 1.16, p = 0.51). Male gender was associated with longer-term survival (p = .011), but surgery type (OPCAB vs CPB) was not (p = 0.23).

CONCLUSIONS

OPCAB provides significant early mortality and morbidity advantages, especially for women. During the 10-year follow-up, OPCAB and CPB result in similar survival, regardless of gender.

Authors+Show Affiliations

Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA. john.puskas@emoryhealthcare.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18805149

Citation

Puskas, John D., et al. "Off-pump Coronary Bypass Provides Reduced Mortality and Morbidity and Equivalent 10-year Survival." The Annals of Thoracic Surgery, vol. 86, no. 4, 2008, pp. 1139-46; discussion 1146.
Puskas JD, Kilgo PD, Lattouf OM, et al. Off-pump coronary bypass provides reduced mortality and morbidity and equivalent 10-year survival. Ann Thorac Surg. 2008;86(4):1139-46; discussion 1146.
Puskas, J. D., Kilgo, P. D., Lattouf, O. M., Thourani, V. H., Cooper, W. A., Vassiliades, T. A., Chen, E. P., Vega, J. D., & Guyton, R. A. (2008). Off-pump coronary bypass provides reduced mortality and morbidity and equivalent 10-year survival. The Annals of Thoracic Surgery, 86(4), 1139-46; discussion 1146. https://doi.org/10.1016/j.athoracsur.2008.05.073
Puskas JD, et al. Off-pump Coronary Bypass Provides Reduced Mortality and Morbidity and Equivalent 10-year Survival. Ann Thorac Surg. 2008;86(4):1139-46; discussion 1146. PubMed PMID: 18805149.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Off-pump coronary bypass provides reduced mortality and morbidity and equivalent 10-year survival. AU - Puskas,John D, AU - Kilgo,Patrick D, AU - Lattouf,Omar M, AU - Thourani,Vinod H, AU - Cooper,William A, AU - Vassiliades,Thomas A, AU - Chen,Edward P, AU - Vega,J David, AU - Guyton,Robert A, PY - 2008/01/29/received PY - 2008/05/22/revised PY - 2008/05/28/accepted PY - 2008/9/23/pubmed PY - 2008/10/23/medline PY - 2008/9/23/entrez SP - 1139-46; discussion 1146 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 86 IS - 4 N2 - BACKGROUND: This study compared in-hospital major adverse cardiac events (MACE) and long-term survival after off-pump (OPCAB) vs on-pump (CPB) coronary artery bypass grafting (CABG). METHODS: Reviewed were 12,812 consecutive isolated CABG patients from 1997 to 2006. A propensity score (PS), including 40 preoperative risk factors, balanced characteristics between OPCAB and CPB groups. Multiple logistic regression models tested whether gender or surgery type, or their interaction, were associated with in-hospital mortality and MACE. A proportional hazards regression model and Kaplan-Meier curves related long-term survival with gender, surgery type, and their interaction, adjusted for PS and age. RESULTS: OPCAB was associated with a significant reduction in operative mortality (adjusted odds ratio [AOR], 0.68; p = 0.045), stroke (AOR, 0.48; p < 0.001), and MACE (AOR, 0.66; p = 0.018). Female gender was associated with higher rates of death (AOR, 1.93), stroke (AOR, 1.82), myocardial infarction (AOR, 2.19), and MACE (AOR, 1.97; each p < 0.001). Women disproportionately benefited from OPCAB in operative mortality (p = 0.04). Odds of death for women on CPB were higher than for women treated with OPCAB (AOR, 2.07, p = 0.005). Odds of death for men on CPB were not significantly higher than for men treated with OPCAB (AOR, 1.16, p = 0.51). Male gender was associated with longer-term survival (p = .011), but surgery type (OPCAB vs CPB) was not (p = 0.23). CONCLUSIONS: OPCAB provides significant early mortality and morbidity advantages, especially for women. During the 10-year follow-up, OPCAB and CPB result in similar survival, regardless of gender. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/18805149/Off_pump_coronary_bypass_provides_reduced_mortality_and_morbidity_and_equivalent_10_year_survival_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(08)01324-6 DB - PRIME DP - Unbound Medicine ER -