A comparison of short- and long-term outcomes after off-pump and on-pump coronary artery bypass graft surgery with sternotomy

Michael J. Racz, Edward L. Hannan, O. Wayne Isom, Valavanur A. Subramanian, Robert H. Jones, Jeffrey P Gold, Thomas J. Ryan, Alan Hartman, Alfred T. Culliford, Edward Bennett, Robert A. Lancey, Eric A. Rose

Research output: Contribution to journalArticle

117 Citations (Scopus)

Abstract

OBJECTIVES: This study was designed to compare in-hospital mortality and complications and three-year mortality and revascularization for off-pump and on-pump coronary artery bypass graft (CABG) surgery after adjusting for patient risk. BACKGROUND: The use of off-pump CABG surgery has increased tremendously in recent years, but little is known about its long-term outcomes relative to on-pump CABG surgery, and most studies have been very small. METHODS: Short- and long-term outcomes (inpatient mortality and complications, three-year risk-adjusted mortality, and mortality/revascularization) were explored for patients who underwent off-pump CABG surgery (9,135 patients) and on-pump CABG surgery (59,044 patients) with median sternotomy from 1997 to 2000 in the state of New York. RESULTS: Risk-adjusted inpatient mortality was 2.02% for off-pump versus 2.16% for on-pump (p = 0.390). Off-pump patients had lower rates of perioperative stroke (1.6% vs. 2.0%, p = 0.003) and bleeding requiring reoperation (1.6% vs. 2.2%, p < 0.001) and higher rates of gastrointestinal bleeding, perforation, or infarction (1.2% vs. 0.9%, p = 0.003). Off-pump patients had lower postoperative lengths of stay (median 5 days vs. 6 days, p < 0.001). On-pump patients had higher three-year survival (adjusted risk ratio [RR] =1.086, p = 0.045) and higher freedom from death or revascularization (adjusted RR = 1.232, p < 0.001). When analyses were limited to 1999 to 2000, the two-year adjusted hazard ratio for survival was not significant (adjusted RR = 0.99, p = 0.81). CONCLUSIONS: On-pump patients experience better long-term survival and freedom from revascularization than off-pump patients. However, the survival benefit from on-pump procedures was no longer present in the last two years of the study.

Original languageEnglish (US)
Pages (from-to)557-564
Number of pages8
JournalJournal of the American College of Cardiology
Volume43
Issue number4
DOIs
StatePublished - Feb 18 2004

Fingerprint

Sternotomy
Coronary Artery Bypass
Transplants
Mortality
Off-Pump Coronary Artery Bypass
Survival
Odds Ratio
Inpatients
Hemorrhage
Hospital Mortality
Reoperation
Infarction
Length of Stay
Stroke

Keywords

  • Cardiac Surgery Reporting System
  • Coronary artery bypass graft
  • Hazard ratio
  • Myocardial infarction
  • Percutaneous coronary intervention
  • Randomized controlled trial

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

A comparison of short- and long-term outcomes after off-pump and on-pump coronary artery bypass graft surgery with sternotomy. / Racz, Michael J.; Hannan, Edward L.; Isom, O. Wayne; Subramanian, Valavanur A.; Jones, Robert H.; Gold, Jeffrey P; Ryan, Thomas J.; Hartman, Alan; Culliford, Alfred T.; Bennett, Edward; Lancey, Robert A.; Rose, Eric A.

In: Journal of the American College of Cardiology, Vol. 43, No. 4, 18.02.2004, p. 557-564.

Research output: Contribution to journalArticle

Racz, MJ, Hannan, EL, Isom, OW, Subramanian, VA, Jones, RH, Gold, JP, Ryan, TJ, Hartman, A, Culliford, AT, Bennett, E, Lancey, RA & Rose, EA 2004, 'A comparison of short- and long-term outcomes after off-pump and on-pump coronary artery bypass graft surgery with sternotomy', Journal of the American College of Cardiology, vol. 43, no. 4, pp. 557-564. https://doi.org/10.1016/j.jacc.2003.09.045
Racz, Michael J. ; Hannan, Edward L. ; Isom, O. Wayne ; Subramanian, Valavanur A. ; Jones, Robert H. ; Gold, Jeffrey P ; Ryan, Thomas J. ; Hartman, Alan ; Culliford, Alfred T. ; Bennett, Edward ; Lancey, Robert A. ; Rose, Eric A. / A comparison of short- and long-term outcomes after off-pump and on-pump coronary artery bypass graft surgery with sternotomy. In: Journal of the American College of Cardiology. 2004 ; Vol. 43, No. 4. pp. 557-564.
@article{c3b88c974f184b3b90a04fb03cae946c,
title = "A comparison of short- and long-term outcomes after off-pump and on-pump coronary artery bypass graft surgery with sternotomy",
abstract = "OBJECTIVES: This study was designed to compare in-hospital mortality and complications and three-year mortality and revascularization for off-pump and on-pump coronary artery bypass graft (CABG) surgery after adjusting for patient risk. BACKGROUND: The use of off-pump CABG surgery has increased tremendously in recent years, but little is known about its long-term outcomes relative to on-pump CABG surgery, and most studies have been very small. METHODS: Short- and long-term outcomes (inpatient mortality and complications, three-year risk-adjusted mortality, and mortality/revascularization) were explored for patients who underwent off-pump CABG surgery (9,135 patients) and on-pump CABG surgery (59,044 patients) with median sternotomy from 1997 to 2000 in the state of New York. RESULTS: Risk-adjusted inpatient mortality was 2.02{\%} for off-pump versus 2.16{\%} for on-pump (p = 0.390). Off-pump patients had lower rates of perioperative stroke (1.6{\%} vs. 2.0{\%}, p = 0.003) and bleeding requiring reoperation (1.6{\%} vs. 2.2{\%}, p < 0.001) and higher rates of gastrointestinal bleeding, perforation, or infarction (1.2{\%} vs. 0.9{\%}, p = 0.003). Off-pump patients had lower postoperative lengths of stay (median 5 days vs. 6 days, p < 0.001). On-pump patients had higher three-year survival (adjusted risk ratio [RR] =1.086, p = 0.045) and higher freedom from death or revascularization (adjusted RR = 1.232, p < 0.001). When analyses were limited to 1999 to 2000, the two-year adjusted hazard ratio for survival was not significant (adjusted RR = 0.99, p = 0.81). CONCLUSIONS: On-pump patients experience better long-term survival and freedom from revascularization than off-pump patients. However, the survival benefit from on-pump procedures was no longer present in the last two years of the study.",
keywords = "Cardiac Surgery Reporting System, Coronary artery bypass graft, Hazard ratio, Myocardial infarction, Percutaneous coronary intervention, Randomized controlled trial",
author = "Racz, {Michael J.} and Hannan, {Edward L.} and Isom, {O. Wayne} and Subramanian, {Valavanur A.} and Jones, {Robert H.} and Gold, {Jeffrey P} and Ryan, {Thomas J.} and Alan Hartman and Culliford, {Alfred T.} and Edward Bennett and Lancey, {Robert A.} and Rose, {Eric A.}",
year = "2004",
month = "2",
day = "18",
doi = "10.1016/j.jacc.2003.09.045",
language = "English (US)",
volume = "43",
pages = "557--564",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "4",

}

TY - JOUR

T1 - A comparison of short- and long-term outcomes after off-pump and on-pump coronary artery bypass graft surgery with sternotomy

AU - Racz, Michael J.

AU - Hannan, Edward L.

AU - Isom, O. Wayne

AU - Subramanian, Valavanur A.

AU - Jones, Robert H.

AU - Gold, Jeffrey P

AU - Ryan, Thomas J.

AU - Hartman, Alan

AU - Culliford, Alfred T.

AU - Bennett, Edward

AU - Lancey, Robert A.

AU - Rose, Eric A.

PY - 2004/2/18

Y1 - 2004/2/18

N2 - OBJECTIVES: This study was designed to compare in-hospital mortality and complications and three-year mortality and revascularization for off-pump and on-pump coronary artery bypass graft (CABG) surgery after adjusting for patient risk. BACKGROUND: The use of off-pump CABG surgery has increased tremendously in recent years, but little is known about its long-term outcomes relative to on-pump CABG surgery, and most studies have been very small. METHODS: Short- and long-term outcomes (inpatient mortality and complications, three-year risk-adjusted mortality, and mortality/revascularization) were explored for patients who underwent off-pump CABG surgery (9,135 patients) and on-pump CABG surgery (59,044 patients) with median sternotomy from 1997 to 2000 in the state of New York. RESULTS: Risk-adjusted inpatient mortality was 2.02% for off-pump versus 2.16% for on-pump (p = 0.390). Off-pump patients had lower rates of perioperative stroke (1.6% vs. 2.0%, p = 0.003) and bleeding requiring reoperation (1.6% vs. 2.2%, p < 0.001) and higher rates of gastrointestinal bleeding, perforation, or infarction (1.2% vs. 0.9%, p = 0.003). Off-pump patients had lower postoperative lengths of stay (median 5 days vs. 6 days, p < 0.001). On-pump patients had higher three-year survival (adjusted risk ratio [RR] =1.086, p = 0.045) and higher freedom from death or revascularization (adjusted RR = 1.232, p < 0.001). When analyses were limited to 1999 to 2000, the two-year adjusted hazard ratio for survival was not significant (adjusted RR = 0.99, p = 0.81). CONCLUSIONS: On-pump patients experience better long-term survival and freedom from revascularization than off-pump patients. However, the survival benefit from on-pump procedures was no longer present in the last two years of the study.

AB - OBJECTIVES: This study was designed to compare in-hospital mortality and complications and three-year mortality and revascularization for off-pump and on-pump coronary artery bypass graft (CABG) surgery after adjusting for patient risk. BACKGROUND: The use of off-pump CABG surgery has increased tremendously in recent years, but little is known about its long-term outcomes relative to on-pump CABG surgery, and most studies have been very small. METHODS: Short- and long-term outcomes (inpatient mortality and complications, three-year risk-adjusted mortality, and mortality/revascularization) were explored for patients who underwent off-pump CABG surgery (9,135 patients) and on-pump CABG surgery (59,044 patients) with median sternotomy from 1997 to 2000 in the state of New York. RESULTS: Risk-adjusted inpatient mortality was 2.02% for off-pump versus 2.16% for on-pump (p = 0.390). Off-pump patients had lower rates of perioperative stroke (1.6% vs. 2.0%, p = 0.003) and bleeding requiring reoperation (1.6% vs. 2.2%, p < 0.001) and higher rates of gastrointestinal bleeding, perforation, or infarction (1.2% vs. 0.9%, p = 0.003). Off-pump patients had lower postoperative lengths of stay (median 5 days vs. 6 days, p < 0.001). On-pump patients had higher three-year survival (adjusted risk ratio [RR] =1.086, p = 0.045) and higher freedom from death or revascularization (adjusted RR = 1.232, p < 0.001). When analyses were limited to 1999 to 2000, the two-year adjusted hazard ratio for survival was not significant (adjusted RR = 0.99, p = 0.81). CONCLUSIONS: On-pump patients experience better long-term survival and freedom from revascularization than off-pump patients. However, the survival benefit from on-pump procedures was no longer present in the last two years of the study.

KW - Cardiac Surgery Reporting System

KW - Coronary artery bypass graft

KW - Hazard ratio

KW - Myocardial infarction

KW - Percutaneous coronary intervention

KW - Randomized controlled trial

UR - http://www.scopus.com/inward/record.url?scp=10744222250&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=10744222250&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2003.09.045

DO - 10.1016/j.jacc.2003.09.045

M3 - Article

VL - 43

SP - 557

EP - 564

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 4

ER -