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CORONARY: Off-pump, on-pump CABG have similar outcomes
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A composite outcome of cardiac complications was the same at the 5-year follow-up for patients who underwent CABG off-pump and on-pump, according to results from the CORONARY study.
“The technique of performing CABG on a beating heart (off-pump CABG) was developed to decrease the risk of perioperative complications and to improve long-term outcomes; some complications, both perioperative and long term, may be related to the use of cardiopulmonary bypass and to cross-clamping of the aorta in association with the on-pump CABG procedure,” André Lamy, MD, a professor in the department of surgery at Hamilton Health Sciences in Ontario, Canada, and colleagues wrote.
Researchers randomly assigned patients (n = 4,752) with CAD to undergo CABG with a beating-heart technique (off-pump) and with cardiopulmonary bypass (on-pump). Lamy and colleagues assessed the composite outcome of death, stroke, MI, renal failure or repeat revascularization at the end of the study period of 5 years (mean, 4.8 years).
The study resulted in no significant differences between the off-pump CABG group and the on-pump CABG group in the rate of composite outcome (off-pump, 23.1%; on-pump, 23.6%; HR = 0.98; 95% CI, 0.87-1.1).
There were no differences between the groups in repeat coronary revascularization (off-pump, 2.8%; on-pump, 2.3%; HR = 1.21; 95% CI, 0.85-1.23) or in any other component of the composite outcome, Lamy and colleagues wrote.
Researchers also found that the mean cost per patient did not differ significantly between the off-pump group and the on-pump group ($15,107 vs. $14,992, respectively; between-group difference, $115; 95% CI, -$697 to $927). There were also no significant differences in quality-of-life measures between the two groups.
“Our trial emphasizes the importance of long-term follow-up in surgical trials and indicates that new surgical techniques should be subject to rigorous comparative and large randomized trials before they are adopted widely in practice,” researchers wrote. “Our trial results indicate that both procedures are equally effective and safe.” – by Cassie Homer
Disclosure: Lamy reports receiving grant support from the Canadian Institute of Health Research during the conduct of the study. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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