Key result
Off-pump CABG resulted in significantly lower levels of cardiac biomarkers at 1 and 4 hours post-operatively compared to on-pump CABG, indicating less immediate myocardial damage.
Why the study?
Cardiopulmonary bypass and aortic cross-clamping during CABG may cause additive myocardial damage, prompting comparison of immediate post-operative cardiac biomarker levels between ONCAB and OPCAB.
Does off-pump CABG reduce post-operative cardiac biomarker elevation compared to on-pump CABG in patients with ischemic heart disease?
Observational (n=106)
No
Does off-pump CABG reduce post-operative cardiac biomarker elevation compared to on-pump CABG in patients with ischemic heart disease?
p-value: p=<0.0001
Off-pump CABG is associated with less immediate post-operative myocardial damage compared to on-pump CABG, though biomarker levels equalize by 20 hours post-surgery.
Off-pump CABG was associated with lower early biomarkers; hypothesis-generating and requires RCT confirmation before practice change.
Background: Coronary artery bypass grafting (CABG) is an important modality of treatment for ischemic heart disease. Both off-pump and on-pump CABG have direct effect on the level cardiac biomarkers in the perioperative period. The use of cardiopulmonary bypass (CPB) and aortic cross-clamping may cause additive myocardial damage leading to further elevation of blood markers. The present study is aimed at measuring and comparing the cardiac biomarker levels in immediate post-operative period after on-pump CABG (ONCAB) and off-pump CABG (OPCAB). Methods: All the patients who underwent CABG from January 2015 to June 2016 on elective or emergency basis at Nilratan Sircar Medical College & Hospital have been included in the study. Total 106 patients were operated for CABG of which 75 patients were operated for OPCAB and 31 patients were operated for ONCAB. For the comparison of data the blood markers Troponin-T (Trop-T) and Creatine Kinase-MB (CK-MB) are measured during anesthesia before surgery, post-operatively after 1 hour, post-operatively after 4 hours and post-operatively after 20 hours. All recorded data are analyzed using standard statistical methods. Results: We found the markers are elevated immediately after surgery and gradually come down within 24 hours after surgery in both OPCAB and ONCAB groups. The elevation is more after ONCAB than OPCAB group in immediate post-operative period but the difference is not significant after 20 hours of surgery. Conclusion: Elevated levels of cardiac biomarkers in the immediate post-operative period indicate myocardial damage during surgery, especially after ONCAB in comparison to OPCAB. This may attribute to the better hemodynamic stability in the immediate post-operative period after OPCAB than ONCAB assuming comparable and adequate revascularization in patients of both groups. The avoidance of CPB and cross-clamp may explain better myocardial functioning immediately after OPCAB. But after 20 hours, the level of cardiac markers is comparable in both groups indicating little difference in post-operative recovery and long-term prognosis.
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Munshi et al. (2020) conducted an observational in Coronary artery disease requiring CABG (n=106). Off-pump CABG (OPCAB) vs. On-pump CABG (ONCAB) was evaluated on Cardiac biomarker levels (CK-MB and Trop-T) at 1 and 4 hours post-operatively (p=<0.0001). Off-pump CABG resulted in significantly lower levels of cardiac biomarkers at 1 and 4 hours post-operatively compared to on-pump CABG, indicating less immediate myocardial damage.
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