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GOPCABE: No difference between on-pump, off-pump CABG in older patients

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SAN FRANCISCO — Outcomes with on-pump vs. off-pump CABG were similar in patients aged 75 years or older, researchers reported at the American College of Cardiology Scientific Sessions.

For the GOPCABE study, Anno Diegeler, MD, PhD, of the Heart Center Bad Neustadt in Germany, and colleagues randomly assigned 2,539 patients aged at least 75 years to off-pump or on-pump CABG. The primary endpoint was a composite of death, stroke, MI, repeat revascularization or new renal-replacement therapy at 30 days and 12 months after surgery.

 

Anno Diegeler

The study results, which were simultaneously published in The New England Journal of Medicine, revealed no significant differences in the composite outcome between the off-pump and on-pump groups at 30 days (7.8% vs. 8.2%), with an OR of 0.95 (95% CI, 0.71-1.28). After evaluating the components individually, the researchers also found no significant differences between groups in death, stroke, MI and renal-replacement therapy. Repeat revascularization, however, was more frequent in the off-pump group vs. the on-pump group (1.3% vs. 0.4%), with an OR of 2.42 (95% CI, 1.03-5.72).

Similarly, outcomes differed little at 12 months in terms of the composite endpoint (off-pump CABG, 13.1% vs. on-pump CABG, 14%), with an HR of 0.93 (95% CI, 0.76-1.16), according to the study data. Additionally, no between-group differences were observed in any of the individual components of the composite outcome.

Results remained comparable even after exclusion of 177 patients who crossed over from one treatment arm to the other, the researchers noted.

“Our study shows that coronary bypass surgery can be performed in the elderly population with excellent results, and this is equally true for both techniques. These findings suggest clinicians can select the lower-cost off-pump procedure without risk to the patient,” Diegeler said in a press release.

For more information:

Diegeler A. Late-breaking clinical trials IV: General cardiology. Presented at: American College of Cardiology Scientific Sessions; March 9-12, 2013; San Francisco.

Diegeler A. N Engl J Med. 2013;doi:10.1056/NEJM0a121166.

Disclosure: The study was supported by Maquet. Diegeler reports receiving lecture fees and travel expense and honorarium from Maquet.