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ROOBY-FS: Event-free survival rates lower with off-pump CABG
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Patients who underwent off-pump CABG had reduced rates of event-free and 5-year survival compared with those who received on-pump CABG, according to a study published in The New England Journal of Medicine.
A. Laurie W. Shroyer, PhD, MSHA, professor of surgery, vice chair for research and assistant dean for educational research at Stony Brook School of Medicine in New York, and colleagues assessed 5-year clinical outcomes in 2,203 patients who were assigned on-pump (n = 1,099; mean age, 63 years; 100% men) or off-pump CABG (n = 1,104; mean age, 63 years; 99% men) in the original ROOBY study from February 2002 to June 2007.
The primary outcomes were all-cause death and major adverse CV events, which included all-cause death, nonfatal MI and repeat revascularization with CABG or PCI. Secondary outcomes were 5-year rates of nonfatal MI, cardiac death and repeat revascularization, in addition to a composite outcome of repeat revascularization, cardiac death or MI. The secondary outcomes were significant if they achieved a P value < .01.
At 5 years, the rate of death was 15.2% in patients assigned off-pump CABG vs. 11.9% in the on-pump group (RR = 1.28; 95% CI, 1.03-1.58). Patients in the off-pump group had a higher rate of major adverse CV events (31%) compared with the on-pump group (27.1%; RR = 1.14; 95% CI, 1-1.3).
Differences between the off-pump and on-pump groups were not statistically significant regarding secondary outcomes, including death from cardiac causes (6.3% vs. 5.3%), nonfatal MI (12.1% vs. 9.6%), overall rate of repeat revascularization (13.1% vs. 11.9%) and repeat CABG (1.4% vs. 0.5%).
“Given the results, it appears that innovative surgical approaches — such as the more technically demanding off-pump procedure — may not always provide superior clinical outcomes,” Shroyer and colleagues wrote. “Additional long-term follow-up evaluating these same outcomes rigorously at 10 years after CABG appears to be warranted.”
In a related editorial, Eugene H. Blackstone, MD, full-time head of clinical investigations at the Sydell and Arnold Miller Family Heart and Vascular Institute and a staff member at the department of thoracic and cardiovascular surgery at the Quantitative Health Sciences and Transplant Center at Cleveland Clinic, and Joseph F. Sabik III, MD, chairman of the department of surgery at University Hospitals Cleveland Medical Center and vice president of surgical operations and surgeon-in-chief at University Hospitals in Cleveland, wrote: “Although the controversy about on-pump vs. off-pump CABG is likely to continue, it may be time to abandon this discussion and focus on identifying which patients benefit from which procedure. Off-pump CABG is probably better for some patients and on-pump CABG for others, although the majority would do well with either.” – by Darlene Dobkowski
Disclosures: The authors and Blackstone report no relevant financial disclosures. Sabik reports serving as a member of a cardiac surgery advisory council for Medtronic.
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