| Title: |
Five-Year Outcomes after On-Pump and Off-Pump Coronary-Artery Bypass. |
| Authors: |
Shroyer, A. Laurie1,2 annie.shroyer@va.gov; Hattler, Brack2,3; Wagner, Todd H.4; Collins, Joseph F.5; Baltz, Janet H.2; Quin, Jacquelyn A.6; Almassi, G. Hossein7; Kozora, Elizabeth8; Bakaeen, Faisal9,10; Cleveland, Joseph C.2,3; Bishawi, Muath1,11; Grover, Frederick L.2,3; Cleveland, Joseph C Jr12 (AUTHOR); Veterans Affairs ROOBY-FS Group (CORPORATE AUTHOR) |
| Source: |
New England Journal of Medicine. 8/17/2017, Vol. 377 Issue 7, p623-632. 10p. |
| Subject Terms: |
*CORONARY artery bypass; *CARDIOPULMONARY bypass; *REVASCULARIZATION (Surgery); *OPERATIVE surgery; *CLINICAL trials; *CARDIOVASCULAR diseases; *COMPARATIVE studies; *LONGITUDINAL method; *VETERANS; *RESEARCH methodology; *MEDICAL cooperation; *PROGNOSIS; *RESEARCH; *EVALUATION research; *RANDOMIZED controlled trials; *KAPLAN-Meier estimator; *CONFOUNDING variables |
| Abstract: |
Background: Coronary-artery bypass grafting (CABG) surgery may be performed either with cardiopulmonary bypass (on pump) or without cardiopulmonary bypass (off pump). We report the 5-year clinical outcomes in patients who had been included in the Veterans Affairs trial of on-pump versus off-pump CABG.Methods: From February 2002 through June 2007, we randomly assigned 2203 patients at 18 medical centers to undergo either on-pump or off-pump CABG, with 1-year assessments completed by May 2008. The two primary 5-year outcomes were death from any cause and a composite outcome of major adverse cardiovascular events, defined as death from any cause, repeat revascularization (CABG or percutaneous coronary intervention), or nonfatal myocardial infarction. Secondary 5-year outcomes included death from cardiac causes, repeat revascularization, and nonfatal myocardial infarction. Primary outcomes were assessed at a P value of 0.05 or less, and secondary outcomes at a P value of 0.01 or less.Results: The rate of death at 5 years was 15.2% in the off-pump group versus 11.9% in the on-pump group (relative risk, 1.28; 95% confidence interval [CI], 1.03 to 1.58; P=0.02). The rate of major adverse cardiovascular events at 5 years was 31.0% in the off-pump group versus 27.1% in the on-pump group (relative risk, 1.14; 95% CI, 1.00 to 1.30; P=0.046). For the 5-year secondary outcomes, no significant differences were observed: for nonfatal myocardial infarction, the rate was 12.1% in the off-pump group and 9.6% in the on-pump group (P=0.05); for death from cardiac causes, the rate was 6.3% and 5.3%, respectively (P=0.29); for repeat revascularization, the rate was 13.1% and 11.9%, respectively (P=0.39); and for repeat CABG, the rate was 1.4% and 0.5%, respectively (P=0.02).Conclusions: In this randomized trial, off-pump CABG led to lower rates of 5-year survival and event-free survival than on-pump CABG. (Funded by the Department of Veterans Affairs Office of Research and Development Cooperative Studies Program and others; ROOBY-FS ClinicalTrials.gov number, NCT01924442 .). [ABSTRACT FROM AUTHOR] |
| Database: |
Academic Search Index |