On-Pump vs Off-Pump coronary artery bypass surgery in atrial fibrillation. Analysis from the polish national registry of cardiac surgery procedures (KROK).
<h4>Background</h4>No single randomized study has ever before addressed the safety of On-Pump coronary artery bypass grafting (CABG) vs Off-Pump CABG in the setting of atrial fibrillation (AF) and data from small observational samples remain inconclusive.<h4>Methods and findings<...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2020-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0231950 |
| _version_ | 1819028728151277568 |
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| author | Mariusz Kowalewski Marek Jasiński Jakub Staromłyński Marian Zembala Kazimierz Widenka Mirosław Brykczyński Jacek Skiba Michał Zembala Krzysztof Bartuś Tomasz Hirnle Inga Dziembowska Piotr Knapik Zdzisław Tobota Bohdan Maruszewski Piotr Suwalski KROK Investigators |
| author_facet | Mariusz Kowalewski Marek Jasiński Jakub Staromłyński Marian Zembala Kazimierz Widenka Mirosław Brykczyński Jacek Skiba Michał Zembala Krzysztof Bartuś Tomasz Hirnle Inga Dziembowska Piotr Knapik Zdzisław Tobota Bohdan Maruszewski Piotr Suwalski KROK Investigators |
| author_sort | Mariusz Kowalewski |
| collection | DOAJ |
| description | <h4>Background</h4>No single randomized study has ever before addressed the safety of On-Pump coronary artery bypass grafting (CABG) vs Off-Pump CABG in the setting of atrial fibrillation (AF) and data from small observational samples remain inconclusive.<h4>Methods and findings</h4>Procedural data from KROK (Polish National Registry of Cardiac Surgery Procedures) were retrospectively collected. Of initial 188,972 patients undergoing CABG, 7,913 presented with baseline AF (76.0% men, mean age 69.1±8.2) and underwent CABG without concomitant valve surgery between 2006-2019 in 37 reference centers across Poland. Mean follow-up was 4.7±3.5 years (median 4.3 IQR 1.7-7.4). Cox proportional hazards models were used for computations. Of included patients, 3,681 underwent On-Pump- (46.52%) as compared to 4,232 (53.48%) who underwent Off-Pump CABG. Patients in the latter group less frequently were candidates for complete revascularization (P<0.001). In an unadjusted comparison, On-Pump surgery was associated with significantly worse survival at 30 days: HR: 1.28; 95%CIs: (1.07-1.53); P = 0.007. Along the 13-year study period, the trend shifted in favor of On-Pump CABG: HR: 0.92; 95%CIs: (0.83-0.99); P = 0.005. After rigorous propensity matching, 636 pairs were identified. The direction and magnitude of treatment effects was sustained with HRs of 3.58; (95%CIs: 1.34-9.61); p = 0.001 and 0.74; [95%CIs: 0.56-0.98]; p = 0.036) for 30-day and late mortality respectively.<h4>Conclusions</h4>Off-Pump CABG offered 30-day survival benefit to patients undergoing CABG surgery and presenting with underlying AF. On-Pump CABG was associated with significantly improved survival at long term. |
| first_indexed | 2024-12-21T06:02:58Z |
| format | Article |
| id | doaj.art-0da9d924ccad4a85913487de96223887 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-21T06:02:58Z |
| publishDate | 2020-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-0da9d924ccad4a85913487de962238872022-12-21T19:13:43ZengPublic Library of Science (PLoS)PLoS ONE1932-62032020-01-01154e023195010.1371/journal.pone.0231950On-Pump vs Off-Pump coronary artery bypass surgery in atrial fibrillation. Analysis from the polish national registry of cardiac surgery procedures (KROK).Mariusz KowalewskiMarek JasińskiJakub StaromłyńskiMarian ZembalaKazimierz WidenkaMirosław BrykczyńskiJacek SkibaMichał ZembalaKrzysztof BartuśTomasz HirnleInga DziembowskaPiotr KnapikZdzisław TobotaBohdan MaruszewskiPiotr SuwalskiKROK Investigators<h4>Background</h4>No single randomized study has ever before addressed the safety of On-Pump coronary artery bypass grafting (CABG) vs Off-Pump CABG in the setting of atrial fibrillation (AF) and data from small observational samples remain inconclusive.<h4>Methods and findings</h4>Procedural data from KROK (Polish National Registry of Cardiac Surgery Procedures) were retrospectively collected. Of initial 188,972 patients undergoing CABG, 7,913 presented with baseline AF (76.0% men, mean age 69.1±8.2) and underwent CABG without concomitant valve surgery between 2006-2019 in 37 reference centers across Poland. Mean follow-up was 4.7±3.5 years (median 4.3 IQR 1.7-7.4). Cox proportional hazards models were used for computations. Of included patients, 3,681 underwent On-Pump- (46.52%) as compared to 4,232 (53.48%) who underwent Off-Pump CABG. Patients in the latter group less frequently were candidates for complete revascularization (P<0.001). In an unadjusted comparison, On-Pump surgery was associated with significantly worse survival at 30 days: HR: 1.28; 95%CIs: (1.07-1.53); P = 0.007. Along the 13-year study period, the trend shifted in favor of On-Pump CABG: HR: 0.92; 95%CIs: (0.83-0.99); P = 0.005. After rigorous propensity matching, 636 pairs were identified. The direction and magnitude of treatment effects was sustained with HRs of 3.58; (95%CIs: 1.34-9.61); p = 0.001 and 0.74; [95%CIs: 0.56-0.98]; p = 0.036) for 30-day and late mortality respectively.<h4>Conclusions</h4>Off-Pump CABG offered 30-day survival benefit to patients undergoing CABG surgery and presenting with underlying AF. On-Pump CABG was associated with significantly improved survival at long term.https://doi.org/10.1371/journal.pone.0231950 |
| spellingShingle | Mariusz Kowalewski Marek Jasiński Jakub Staromłyński Marian Zembala Kazimierz Widenka Mirosław Brykczyński Jacek Skiba Michał Zembala Krzysztof Bartuś Tomasz Hirnle Inga Dziembowska Piotr Knapik Zdzisław Tobota Bohdan Maruszewski Piotr Suwalski KROK Investigators On-Pump vs Off-Pump coronary artery bypass surgery in atrial fibrillation. Analysis from the polish national registry of cardiac surgery procedures (KROK). PLoS ONE |
| title | On-Pump vs Off-Pump coronary artery bypass surgery in atrial fibrillation. Analysis from the polish national registry of cardiac surgery procedures (KROK). |
| title_full | On-Pump vs Off-Pump coronary artery bypass surgery in atrial fibrillation. Analysis from the polish national registry of cardiac surgery procedures (KROK). |
| title_fullStr | On-Pump vs Off-Pump coronary artery bypass surgery in atrial fibrillation. Analysis from the polish national registry of cardiac surgery procedures (KROK). |
| title_full_unstemmed | On-Pump vs Off-Pump coronary artery bypass surgery in atrial fibrillation. Analysis from the polish national registry of cardiac surgery procedures (KROK). |
| title_short | On-Pump vs Off-Pump coronary artery bypass surgery in atrial fibrillation. Analysis from the polish national registry of cardiac surgery procedures (KROK). |
| title_sort | on pump vs off pump coronary artery bypass surgery in atrial fibrillation analysis from the polish national registry of cardiac surgery procedures krok |
| url | https://doi.org/10.1371/journal.pone.0231950 |
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