Key result
Off-pump coronary artery bypass grafting resulted in significantly lower postoperative cardiac troponin-I release compared to on-pump surgery, though postoperative left ventricular ejection fraction changes were similar between the two techniques.
Why the study?
Does off-pump CABG reduce myocardial injury biomarkers and improve clinical outcomes compared to on-pump CABG in patients with coronary artery disease?
RCT (n=50)
Single-blind
Randomized
No
Does off-pump CABG reduce myocardial injury biomarkers and improve clinical outcomes compared to on-pump CABG in patients with coronary artery disease?
Absolute Event Rate: 0.69% vs 5.39%
p-value: p=<0.001
May support off-pump CABG to limit injury biomarkers; leaves open clinical outcome differences in larger trials.
Objective: There is no common concencus the clinical results of coronary artery bypass grafting (CABG) surgery patients who underwent off-pump or conventional techniques. Our aim of this study was to compare the changes of myocardial functions, patients' clinical results, biochemical marker release during surgery and postoperatively in On-and Off-Pump CABG surgery. Method: A consecutive series of 50 coronary artery disease (CAD) patients who underwent elective CABG surgery included for this study. The patients were divided into two groups (Group 1, N = 25 and group 2, N = 25). Demographic data including the patients' age, gender, body mass index (BMI), diseased coronary artery numbers, LVEF were similar. Postoperative red package blood cell, fresh frozen plasma, and thrombocyte requirements were high in On-Pump group (p < 0.05). But there was not any significant difference when compared the number of unexpected surgery because of mediastinal bleeding after operations in both groups. Preoperative and postoperative N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP), cardiac Troponin-I (cTnI) levels during and after surgery, and left ventricular ejection fractions (LVEF) prior to discharge from hospital were compared. Results: There were no statistical significancy when compared postoperative mortality and morbidity. The operations time was low in off-pump group (p < 0.05). The NT-proBNP levels were similar in both groups (p > 0.05). However, cTnI levels were significantly higher in the on-pump group (p = 0.0001). Postoperative LVEF decreased significantly in both groups when compared to preoperative echocardiography examinations (p = 0.001). But the changes of postoperative LVEFs in both groups were not statistical significant (p > 0.05). Conclusion: Our study results indicated that cardiac enzyme release was high after On-Pump CABG surgery. However, LVEF decreased in both techniques. There
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Temiztürk et al. (2015) conducted an RCT in Coronary Artery Disease (n=50). Off-Pump Coronary Artery Bypass Grafting (OPCAB) vs. On-Pump (Conventional) CABG was evaluated on Cardiac Troponin-I (cTnI) levels at 24 hours postoperatively (ng/ml) (p=<0.001). Off-pump coronary artery bypass grafting resulted in significantly lower postoperative cardiac troponin-I release compared to on-pump surgery, though postoperative left ventricular ejection fraction changes were similar between the two techniques.
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