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Long-term survival following coronary artery bypass grafting: off-pump versus on-pump strategies.

Abstract：

OBJECTIVES:This study sought to compare long-term survival after off- and on-pump coronary artery bypass grafting (CABG). BACKGROUND:Although several large-scale clinical trials have compared the surgical outcomes between off- and on-pump CABG, the long-term survival has not been compared between the 2 surgical strategies in a reasonably sized cohort. METHODS:We evaluated long-term survival data in 5,203 patients (age 62.9 ± 9.1 years, 1,340 females) who underwent elective isolated CABG (off-pump: n = 2,333; on-pump: n = 2,870) from 1989 through 2012. Vital statuses were validated using the Korean National Registry of Vital Statistics. Long-term survival was compared with the use of propensity scores and inverse probability weighting to adjust selection bias. RESULTS:Patients undergoing on-pump CABG had a higher number of distal anastomoses than those undergoing off-pump CABG (3.7 ± 1.2 vs. 3.0 ± 1.1; p < 0.001). Survival data were complete in 5,167 patients (99.3%), with a median follow-up duration of 6.4 years (interquartile range: 3.7 to 10.5 years; maximum 23.1 years). During follow-up, 1,181 patients (22.7%) died. After adjustment, both groups of patients showed a similar risk of death at 30 days (odds ratio: 0.70; 95% confidence interval [CI]: 0.35 to 1.40; p = 0.31) and up to 1 year (hazard ratio [HR]: 1.11; 95% CI: 0.74 to 1.65; p = 0.62). For overall mortality, however, patients undergoing off-pump CABG were at a significantly higher risk of death (HR: 1.43; 95% CI: 1.19 to 1.71; p < 0.0001) compared with those undergoing on-pump CABG. In subgroup analyses, on-pump CABG conferred survival benefits in most demographic, clinical, and anatomic subgroups compared with off-pump CABG. CONCLUSIONS:In patients undergoing elective isolated CABG, on-pump strategy conferred a long-term survival advantage compared with off-pump strategy.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Kim JB,Yun SC,Lim JW,Hwang SK,Jung SH,Song H,Chung CH,Lee JW,Choo SJ

doi

10.1016/j.jacc.2014.02.584

subject

Has Abstract

pub_date

2014-06-03 00:00:00

pages

2280-8

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(14)01631-3

journal_volume

pub_type

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Long-term survival following coronary artery bypass grafting: off-pump versus on-pump strategies.