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CORONARY: On-pump, off-pump CABG comparable at 1 year
SAN FRANCISCO — New data from the CORONARY study demonstrate that patients who underwent off-pump CABG had similar outcomes at 1 year as patients who underwent on-pump CABG.
At a late-breaking clinical trials session, André Lamy, MD, reported no significant difference between the off-pump and on-pump CABG for the study’s primary composite endpoint of death, stroke, MI or new kidney failure requiring dialysis within 1 year of surgery (12.2% vs. 13.3%; P=.24).
André Lamy
Researchers for the CORONARY study previously looked at this primary endpoint at 30 days and also found the two methods to be statistically neutral in the short term, according to information in a press release.
Besides the primary endpoint, Lamy and colleagues examined the need for coronary revascularization between the off- and on-pump groups. Results were similar, with 1.4% of patients in the off-pump group and 0.8% in the on-pump group requiring this procedure (P=.07).
In other results, “We found a transient improvement in neurocognitive function at hospital discharge among those receiving an off-pump bypass. But at 1 year, our results are similar with both techniques,” Lamy, professor in the division of cardiac surgery at McMaster University in Ontario, Canada, said in the release.
The international, multicenter trial included 4,752 patients from 79 centers in 19 countries. Patients were randomly assigned to off-pump or on-pump CABG after a complete assessment to ensure both techniques were appropriate.
All surgeons participating in the CORONARY study were required to have performed at least 100 cases in the approach used, according to the release.
“In experienced hands, both procedures are reasonable options based on mid-term results,” Lamy said at the conference.
The CORONARY study will follow patients out to 5 years. – by Katie Kalvaitis
For more information:
Lamy A. Late-breaking clinical trials IV: General cardiology. Presented at: American College of Cardiology Scientific Sessions; March 9-12, 2013; San Francisco.
Lamy A. N Engl J Med. 2013;doi:10.1056/NEJMoa1301228.
Disclosure: The CORONARY study was funded by a grant from the Canadian Institutes of Health Research. Lamy reports no relevant financial disclosures.
Perspective
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The significance of this study is particularly related to the neurocognitive dysfunction some patients develop after bypass surgery. Previously, the thought was if one performed CABG off-pump the neurocognitive deficit would be less. These results at one year suggest that there is no difference in overall or specifically in neurocognitive endpoints at one year between off-pump or on-pump surgery. Thus, If a surgeon is good at the off-pump technique, that is acceptable; however, if a surgeon is not experienced in this technique, there is no compelling data based on this trial for a surgeon to switch techniques. The researchers are planning 5-year follow-up, which will be important.