Off-pump versus on-pump coronary artery bypass grafting. Insights from the Arterial Revascularization Trial
<strong>Background</strong> The long-term effects of (OPCAB) continue to be controversial as some studies have reported increased adverse event rates with OPCAB when compared to on-pump coronary artery bypass (ONCAB). The Arterial Revascularization Trial (ART) compared survival after bil...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Journal article |
| Published: |
Elsevier
2017
|
| _version_ | 1797075696599695360 |
|---|---|
| author | Benedetto, U Altman, D Gerry, S Gray, A Lees, B Flather, M Taggart, D on behalf of the ART investigators |
| author_facet | Benedetto, U Altman, D Gerry, S Gray, A Lees, B Flather, M Taggart, D on behalf of the ART investigators |
| author_sort | Benedetto, U |
| collection | OXFORD |
| description | <strong>Background</strong> The long-term effects of (OPCAB) continue to be controversial as some studies have reported increased adverse event rates with OPCAB when compared to on-pump coronary artery bypass (ONCAB). The Arterial Revascularization Trial (ART) compared survival after bilateral versus single internal thoracic artery grafting. The choice of OPCAB versus ONCAB was based on surgeon’s discretion. We performed a post-hoc analysis of the ART to compare 5-year outcomes with two strategies. <strong>Methods</strong> Among 3102 patients enrolled in the ART, we selected 1260 patients who underwent OPCAB versus 1700 patients who underwent ONCAB with cardioplegic arrest for the preent comparison. Primary outcomes were 5-year mortality and incidence of major cardiac and cerebrovascular events (MACCE) including cardiovascular death, myocardial infarction, cerebrovascular accident and revascularization after index procedure. Propensity score matching selected 1260 pairs for final comparison. Stratified Cox models were used for treatment effect estimate. <strong>Results</strong> Hospital mortality was comparable between OPCAB and ONCAB groups (12[1.0%] vs 15[1.2%]; P=0.7). Conversion rate to on pump during OPCAB was 29/1260 (2.3%). When compared to OPCAB not converted, OPCAB converted to on-pump presented a remarkably higher hospital mortality (10.3% vs 0.7%; P<0.001). At 5 years, mortality rate was 110(8.9%) vs. 102(8.3%) in the OPCAB and ONCAB groups respectively with no significant difference (hazard ratio, HR 1.14; 95% confidence interval, CI 0.86-1.52; P=0.35). Incidence of MACCE was 175(14.3) vs. 169 (13.8) in the in the OPCAB and ONCAB groups respectively with no significant difference (HR 1.05; 95%CI 0.84-1.31; P=0.65). <strong>Conclusions</strong> The present post-hoc ART analysis supports the hypothesis that both OPCAB and ONCAB are equally effective and safe. |
| first_indexed | 2024-03-06T23:53:55Z |
| format | Journal article |
| id | oxford-uuid:738da3b2-736c-4b0a-85f7-0ad6cf5dc190 |
| institution | University of Oxford |
| last_indexed | 2024-03-06T23:53:55Z |
| publishDate | 2017 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | oxford-uuid:738da3b2-736c-4b0a-85f7-0ad6cf5dc1902022-03-26T19:57:11ZOff-pump versus on-pump coronary artery bypass grafting. Insights from the Arterial Revascularization TrialJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:738da3b2-736c-4b0a-85f7-0ad6cf5dc190Symplectic Elements at OxfordElsevier2017Benedetto, UAltman, DGerry, SGray, ALees, BFlather, MTaggart, Don behalf of the ART investigators<strong>Background</strong> The long-term effects of (OPCAB) continue to be controversial as some studies have reported increased adverse event rates with OPCAB when compared to on-pump coronary artery bypass (ONCAB). The Arterial Revascularization Trial (ART) compared survival after bilateral versus single internal thoracic artery grafting. The choice of OPCAB versus ONCAB was based on surgeon’s discretion. We performed a post-hoc analysis of the ART to compare 5-year outcomes with two strategies. <strong>Methods</strong> Among 3102 patients enrolled in the ART, we selected 1260 patients who underwent OPCAB versus 1700 patients who underwent ONCAB with cardioplegic arrest for the preent comparison. Primary outcomes were 5-year mortality and incidence of major cardiac and cerebrovascular events (MACCE) including cardiovascular death, myocardial infarction, cerebrovascular accident and revascularization after index procedure. Propensity score matching selected 1260 pairs for final comparison. Stratified Cox models were used for treatment effect estimate. <strong>Results</strong> Hospital mortality was comparable between OPCAB and ONCAB groups (12[1.0%] vs 15[1.2%]; P=0.7). Conversion rate to on pump during OPCAB was 29/1260 (2.3%). When compared to OPCAB not converted, OPCAB converted to on-pump presented a remarkably higher hospital mortality (10.3% vs 0.7%; P<0.001). At 5 years, mortality rate was 110(8.9%) vs. 102(8.3%) in the OPCAB and ONCAB groups respectively with no significant difference (hazard ratio, HR 1.14; 95% confidence interval, CI 0.86-1.52; P=0.35). Incidence of MACCE was 175(14.3) vs. 169 (13.8) in the in the OPCAB and ONCAB groups respectively with no significant difference (HR 1.05; 95%CI 0.84-1.31; P=0.65). <strong>Conclusions</strong> The present post-hoc ART analysis supports the hypothesis that both OPCAB and ONCAB are equally effective and safe. |
| spellingShingle | Benedetto, U Altman, D Gerry, S Gray, A Lees, B Flather, M Taggart, D on behalf of the ART investigators Off-pump versus on-pump coronary artery bypass grafting. Insights from the Arterial Revascularization Trial |
| title | Off-pump versus on-pump coronary artery bypass grafting. Insights from the Arterial Revascularization Trial |
| title_full | Off-pump versus on-pump coronary artery bypass grafting. Insights from the Arterial Revascularization Trial |
| title_fullStr | Off-pump versus on-pump coronary artery bypass grafting. Insights from the Arterial Revascularization Trial |
| title_full_unstemmed | Off-pump versus on-pump coronary artery bypass grafting. Insights from the Arterial Revascularization Trial |
| title_short | Off-pump versus on-pump coronary artery bypass grafting. Insights from the Arterial Revascularization Trial |
| title_sort | off pump versus on pump coronary artery bypass grafting insights from the arterial revascularization trial |
| work_keys_str_mv | AT benedettou offpumpversusonpumpcoronaryarterybypassgraftinginsightsfromthearterialrevascularizationtrial AT altmand offpumpversusonpumpcoronaryarterybypassgraftinginsightsfromthearterialrevascularizationtrial AT gerrys offpumpversusonpumpcoronaryarterybypassgraftinginsightsfromthearterialrevascularizationtrial AT graya offpumpversusonpumpcoronaryarterybypassgraftinginsightsfromthearterialrevascularizationtrial AT leesb offpumpversusonpumpcoronaryarterybypassgraftinginsightsfromthearterialrevascularizationtrial AT flatherm offpumpversusonpumpcoronaryarterybypassgraftinginsightsfromthearterialrevascularizationtrial AT taggartd offpumpversusonpumpcoronaryarterybypassgraftinginsightsfromthearterialrevascularizationtrial AT onbehalfoftheartinvestigators offpumpversusonpumpcoronaryarterybypassgraftinginsightsfromthearterialrevascularizationtrial |