Off-Pump Versus On-Pump Bypass Surgery for Left Main Coronary Artery Disease. Academic Article uri icon

Overview

abstract

  • BACKGROUND: Concerns remain for a greater risk of incomplete revascularization and reduced survival with off-pump coronary artery bypass grafting (CABG) surgery compared with on-pump surgery particularly in patients with left main disease and extensive underlying myocardial ischemia. OBJECTIVES: This study sought to compare outcomes following off-pump versus on-pump surgery for left main disease by performing a post hoc analysis from the multicenter, randomized EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial. METHODS: The EXCEL trial was designed to compare percutaneous coronary intervention with everolimus-eluting stents versus CABG in patients with left main disease. CABG was performed with or without cardiopulmonary bypass (on-pump vs. off-pump surgery) according to the discretion of the operator. The 3-year outcomes in the off-pump and on-pump groups were compared using inverse probability of treatment weighting (IPTW) for treatment effect estimation. RESULTS: Among 923 CABG patients, 652 and 271 patients underwent on-pump and off-pump surgery, respectively. Despite a similar extent of disease, off-pump surgery was associated with a lower rate of revascularization of the left circumflex coronary artery (84.1% vs. 90.0%; p = 0.01) and right coronary artery (31.1% vs. 40.6%; p = 0.007). After IPTW adjustment for baseline differences, off-pump surgery was associated with a significantly increased risk of 3-year all-cause death (8.8% vs. 4.5%; hazard ratio: 1.94; 95% confidence interval: 1.10 to 3.41; p = 0.02) and a nonsignificant difference in the risk for the composite endpoint of death, myocardial infarction, or stroke (11.8% vs. 9.2%; hazard ratio: 1.28; 95% confidence interval: 0.82 to 2.00; p = 0.28). CONCLUSIONS: Among patients with left main disease treated with CABG in the EXCEL trial, off-pump surgery was associated with a lower rate of revascularization of the coronary arteries supplying the inferolateral wall and an increased risk of 3-year all-cause death compared with on-pump surgery.

authors

  • Benedetto, Umberto
  • Puskas, John
  • Kappetein, Arie Pieter
  • Brown, W Morris
  • Horkay, Ferenc
  • Boonstra, Piet W
  • Bogáts, Gabor
  • Noiseux, Nicolas
  • Dressler, Ovidiu
  • Angelini, Gianni D
  • Stone, Gregg W
  • Serruys, Patrick W
  • Sabik, Joseph F
  • Taggart, David P

publication date

  • August 13, 2019

Research

keywords

  • Coronary Artery Bypass
  • Coronary Artery Disease
  • Percutaneous Coronary Intervention

Identity

Scopus Document Identifier

  • 85069941454

Digital Object Identifier (DOI)

  • 10.1016/j.jacc.2019.05.063

PubMed ID

  • 31395122

Additional Document Info

volume

  • 74

issue

  • 6