Key result
Total arterial off-pump CABG with complete revascularization shows no mortality benefit over on-pump CABG.
Why the study?
Little was known regarding the long-term (> 10 years) outcomes and risk factors of total arterial CABG.
Does total arterial off-pump CABG improve long-term all-cause mortality and MACCEs compared to on-pump CABG in patients with stable angina undergoing complete revascularization?
Cohort (n=401)
No
Does total arterial off-pump CABG improve long-term all-cause mortality and MACCEs compared to on-pump CABG in patients with stable angina undergoing complete revascularization?
Total arterial off-pump and on-pump CABG with complete revascularization yield similar long-term survival and MACCE rates, with preoperative dialysis being a strong independent predictor of adverse outcomes.
Answers are grounded in this paper and cite their sources.
Should not yet alter off-pump versus on-pump choice in stable angina; leaves open need for randomized confirmation of equivalence.
Little is known regarding the long-term (> 10 years) outcomes and risk factors of total arterial coronary artery bypass grafting (CABG). This study evaluated the long-term outcomes and risk factors for all-cause mortality and major adverse cardiac and cerebrovascular events (MACCEs) following total arterial on-pump CABG (ONCAB) or off-pump CABG (OPCAB) with complete revascularization. This retrospective cohort analysis enrolled patients with stable angina who underwent total arterial CABG with complete revascularization in our institute between July 2000 and June 2019. The endpoints were all-cause mortality and MACCE incidence, including a comparison between OPCAB and ONCAB. Long-term (10-year) outcomes were analyzed using propensity score-matched pairs, and risk factors were evaluated using univariate and multivariate analyses. Overall, 401 patients who underwent primary total arterial CABG were classified into the OPCAB (n = 269) and ONCAB (n = 132) groups. Using propensity score matching (PSM), 88 patients who underwent OPCAB were matched with 88 patients who underwent ONCAB. The mean follow-up period was 7.9 ± 6.3 years. No significant difference in all-cause mortality (hazard ratio, 1.04; 95% confidence interval, 0.53-2.04; p = 0.9138) and MACCE incidence (hazard ratio, 1.06; 95% confidence interval, 0.68-1.65; p = 0.7901) was observed between the two groups. Renal failure requiring dialysis was a significant risk factor for mortality (p < 0.0001) and MACCEs (p = 0.0003). Long-term outcomes of total arterial OPCAB and ONCAB with complete revascularization showed similar findings using PSM. Renal failure requiring dialysis was a significant risk factor for mortality and morbidity.Journal standard instruction requires an unstructured abstract; hence the headings provided in abstract were deleted. Kindly check and confirm.Thank you for your kindness.Clinical registration number 5598, Tokyo Women's Medical University Hospital.
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Shintomi et al. (2023) conducted a cohort in Stable angina (n=401). Total arterial off-pump coronary artery bypass grafting (OPCAB) vs. Total arterial on-pump coronary artery bypass grafting (ONCAB) was evaluated on All-cause mortality (HR 1.04, 95% CI 0.53-2.04, p=0.9138). Total arterial off-pump coronary artery bypass grafting with complete revascularization showed no significant difference in long-term all-cause mortality compared to on-pump grafting (HR 1.04).
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