No difference in long-term outcomes after on-pump versus off-pump CABG
medwireNews: Five-year outcomes are similar in patients undergoing coronary-artery bypass grafting (CABG) performed with cardiopulmonary bypass (on-pump) versus a beating-heart technique (off-pump), results of the CORONARY trial suggest.
André Lamy (McMaster University, Hamilton, Ontario, Canada) and colleagues showed that 23.6% of patients in the on-pump group experienced the primary composite outcome of death, stroke, myocardial infarction, or renal failure after a mean of 4.8 years of follow-up, compared with 23.1% of patients in the off-pump group (hazard ratio [HR]=0.98).
“Our trial results indicate that both procedures are equally effective and safe,” write the authors in The New England Journal of Medicine.
Additionally, the team found no significant differences in the rates of individual components of the composite outcome between the on-pump and off-pump groups; repeat revascularization was performed in 2.3% and 2.8% of patients, respectively (HR=1.21).
A total of 4752 patients from 19 countries across four continents were randomly assigned to undergo either on-pump or off-pump CABG between 2006 and 2011 in the CORONARY trial. Patients were followed up at 30 days, 1 year, and annually until 5 years after CABG, and data from 98.8% of patients were available at the final 5-year follow-up.
The mean cost associated with CABG was US$ 14,992 (€ 13,813) per patient in the on-pump group and $ 15,107 (€ 13,920) in the off-pump group. Although the authors note that their cost analysis did not take the cost of CABG equipment into account, they say that the cost difference between the two techniques “is neither statistically nor financially significant.”
Quality of life scores on the European Quality of Life–5 Dimensions questionnaire were also similar in the on-pump and off-pump CABG groups after 5 years of follow-up (0.13 and 0.12, respectively).
“It is a testimony to CABG surgery that the increase in the quality of life observed after surgery was maintained to the end of the trial,” write the authors.
Lamy and colleagues note that although off-pump CABG was initially developed to reduce the risk of perioperative complications and improve long-term outcomes, some authors “have recommended that off-pump CABG be abandoned” on the basis of results from nonrandomized trials.
They say that while patients in the off-pump group had higher rates of incomplete revascularization and crossover to the on-pump procedure at 30 days in the CORONARY trial, “at 5 years there was no significant difference in any outcome between the two techniques, even among patients who crossed over to the other procedure or received an incomplete revascularization during their CABG procedure.”
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