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

118 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

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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.
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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.",
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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

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