Key result
Off-pump coronary artery bypass grafting resulted in similar 10-year event-free survival compared to on-pump CABG (64% vs 69.6%; HR 0.88; 95% CI 0.86-1.02; P=0.41).
Why the study?
Does off-pump coronary artery bypass improve long-term event-free survival compared to on-pump coronary artery bypass in patients undergoing multivessel revascularization?
RCT (n=308)
randomly assigned
Does off-pump coronary artery bypass improve long-term event-free survival compared to on-pump coronary artery bypass in patients undergoing multivessel revascularization?
Hazard Ratio: 0.88 (95% CI 0.86–1.02)
Absolute Event Rate: 64% vs 69.6%
p-value: p=0.41
At 10-year follow-up, off-pump CABG showed no significant difference in long-term composite clinical outcomes compared to on-pump CABG, despite fewer grafts and a higher incidence of postoperative atrial fibrillation.
Off-pump CABG offers no long-term event-free survival advantage; confirms equivalence to on-pump in multivessel disease.
It was a randomized trial, and 308 patients undergoing revascularization were randomly assigned: 155 to off-pump coronary artery bypass (OPCAB) and 153 to on-pump coronary artery bypass (ONCAB). End points were freedom from death, myocardial infarction, revascularization, and cerebrovascular accidents. The rates for 10-year, event-free survival for ONCAB versus OPCAB were 69.6% and 64%, (hazard ratio [HR]: 0.88; 95% confidence interval [CI] 0.86-1.02; P = .41), respectively. Adjusted Cox proportional hazard ratio was similar (HR: 0.92; 95% CI 0.61-1.38, P = .68). A difference occurred between the duration of OPCAB and ONCAB, respectively (4.9 ± 1.5 vs 6.6 ± 1.1 h, P < .001). Statistical differences occurred between OPCAB and ONCAB in the length of intensive care unit (ICU) stay (20 ± 2.5 vs 48 ± 10 hours, P < .001), time to extubation (5.5 ± 4.2 vs 10.2 ± 3.5 hours, P < .001), hospital stay (6.7 ± 1.4 vs 9.2 ± 1.3 days, P < .001), higher incidence of atrial fibrillation (AF; 33 vs 5 patients, P < .001), and blood requirements (46 vs 64 patients, P < .001). Grafts per patient was higher in ONCAB (3.15 vs 2.55 grafts, P < .001). No difference existed between the groups in primary composite end points at 10-year follow-up. Although OPCAB surgery was related to a lower number of grafts and higher incidence of AF, it had no effects related to long-term outcomes.
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Hueb et al. (2018) conducted an RCT in multivessel coronary artery disease (n=308). Off-pump coronary artery bypass (OPCAB) vs. On-pump coronary artery bypass (ONCAB) was evaluated on freedom from death, myocardial infarction, revascularization, and cerebrovascular accidents (HR 0.88, 95% CI 0.86-1.02, p=0.41). Off-pump coronary artery bypass grafting resulted in similar 10-year event-free survival compared to on-pump CABG (64% vs 69.6%; HR 0.88; 95% CI 0.86-1.02; P=0.41).
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