Tags

Type your tag names separated by a space and hit enter

Off-pump coronary artery bypass graft surgery in California, 2003 to 2005.
Am Heart J. 2008 Dec; 156(6):1095-102.AH

Abstract

BACKGROUND

The impact of off-pump coronary artery bypass graft surgery (OPCAB) on operative mortality compared to conventional coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CCB) has not been clarified.

METHOD

Patient clinical characteristics were compared between OPCAB and CCB for isolated CABG surgeries in 2003 to 2005 using data from the California CABG outcomes reporting program. A propensity score method and logistic regression models were used to compute propensity-adjusted operative mortality for patients undergoing OPCAB or CCB.

RESULTS

Of 57,284 isolated CABGs, 13,515 (22.9%) were OPCAB. Compared to CCB, OPCAB patients were older, more females/nonwhite, and had a higher prevalence of certain noncardiac risk factors but were fewer with diabetes, acute myocardial infarction, New York Heart Association class IV heart failure or angina, cardiogenic shock, prior cardiac surgery, left main coronary disease, or > or =3-vessel coronary disease (all P < .01). Overall, the propensity-adjusted operative mortalities (PAOMRs) were significantly lower in OPCAB patients compared to CCB patients (OPCAB 2.59% [95% CI 2.52%-2.67%] vs CCB 3.22% [95% CI 3.17%-3.27%]). Off-pump CABG had a protective advantage for all quintile subgroups (all P < .05). However, within the OPCAB cohort, those who converted to CCB intraoperately had higher PAOMR (converters 3.47% [95% CI 3.16%-3.77%] vs nonconverters 2.53% [95% CI 2.46%-2.61%]). Age, female sex, nonwhite race, diabetes, congestive heart failure, prior cadiac surgery, left main disease, and with > or =3 diseased coronary arteries were associated with a higher risk of intraoperative conversion from OPCAB to CCB (all <0.05).

CONCLUSION

OPCAB and CCB patients had significantly different preoperative risk profiles, and OPCAB was associated with lower operative mortality compared to CCB.

Authors+Show Affiliations

Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, CA 95817, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19033004

Citation

Li, Zhongmin, et al. "Off-pump Coronary Artery Bypass Graft Surgery in California, 2003 to 2005." American Heart Journal, vol. 156, no. 6, 2008, pp. 1095-102.
Li Z, Yeo KK, Parker JP, et al. Off-pump coronary artery bypass graft surgery in California, 2003 to 2005. Am Heart J. 2008;156(6):1095-102.
Li, Z., Yeo, K. K., Parker, J. P., Mahendra, G., Young, J. N., & Amsterdam, E. A. (2008). Off-pump coronary artery bypass graft surgery in California, 2003 to 2005. American Heart Journal, 156(6), 1095-102. https://doi.org/10.1016/j.ahj.2008.07.020
Li Z, et al. Off-pump Coronary Artery Bypass Graft Surgery in California, 2003 to 2005. Am Heart J. 2008;156(6):1095-102. PubMed PMID: 19033004.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Off-pump coronary artery bypass graft surgery in California, 2003 to 2005. AU - Li,Zhongmin, AU - Yeo,Khung Keong, AU - Parker,Joseph P, AU - Mahendra,Geeta, AU - Young,J Nilas, AU - Amsterdam,Ezra A, Y1 - 2008/09/30/ PY - 2008/01/23/received PY - 2008/07/19/accepted PY - 2008/11/27/pubmed PY - 2008/12/17/medline PY - 2008/11/27/entrez SP - 1095 EP - 102 JF - American heart journal JO - Am Heart J VL - 156 IS - 6 N2 - BACKGROUND: The impact of off-pump coronary artery bypass graft surgery (OPCAB) on operative mortality compared to conventional coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CCB) has not been clarified. METHOD: Patient clinical characteristics were compared between OPCAB and CCB for isolated CABG surgeries in 2003 to 2005 using data from the California CABG outcomes reporting program. A propensity score method and logistic regression models were used to compute propensity-adjusted operative mortality for patients undergoing OPCAB or CCB. RESULTS: Of 57,284 isolated CABGs, 13,515 (22.9%) were OPCAB. Compared to CCB, OPCAB patients were older, more females/nonwhite, and had a higher prevalence of certain noncardiac risk factors but were fewer with diabetes, acute myocardial infarction, New York Heart Association class IV heart failure or angina, cardiogenic shock, prior cardiac surgery, left main coronary disease, or > or =3-vessel coronary disease (all P < .01). Overall, the propensity-adjusted operative mortalities (PAOMRs) were significantly lower in OPCAB patients compared to CCB patients (OPCAB 2.59% [95% CI 2.52%-2.67%] vs CCB 3.22% [95% CI 3.17%-3.27%]). Off-pump CABG had a protective advantage for all quintile subgroups (all P < .05). However, within the OPCAB cohort, those who converted to CCB intraoperately had higher PAOMR (converters 3.47% [95% CI 3.16%-3.77%] vs nonconverters 2.53% [95% CI 2.46%-2.61%]). Age, female sex, nonwhite race, diabetes, congestive heart failure, prior cadiac surgery, left main disease, and with > or =3 diseased coronary arteries were associated with a higher risk of intraoperative conversion from OPCAB to CCB (all <0.05). CONCLUSION: OPCAB and CCB patients had significantly different preoperative risk profiles, and OPCAB was associated with lower operative mortality compared to CCB. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/19033004/Off_pump_coronary_artery_bypass_graft_surgery_in_California_2003_to_2005_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(08)00653-4 DB - PRIME DP - Unbound Medicine ER -