Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting.

Lamy, André; Devereaux, PJ; Prabhakaran, Dorairaj; Taggart, David P; Hu, Shengshou; Straka, Zbynek; Piegas, Leopoldo S; Avezum, Alvaro; Akar, Ahmet R; Lanas Zanetti, Fernando; +15 more... Jain, Anil R; Noiseux, Nicolas; Padmanabhan, Chandrasekar; Bahamondes, Juan-Carlos; Novick, Richard J; Tao, Liang; Olavegogeascoechea, Pablo A; Airan, Balram; Sulling, Toomas-Andres; Whitlock, Richard P; Ou, Yongning; Gao, Peggy; Pettit, Shirley; Yusuf, Salim; CORONARY Investigators; (2016) Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting. New England Journal of Medicine, 375 (24). pp. 2359-2368. ISSN 0028-4793 DOI: https://doi.org/10.1056/NEJMoa1601564

Abstract

BACKGROUND: We previously reported that there was no significant difference at 30 days or at 1 year in the rate of the composite outcome of death, stroke, myocardial infarction, or renal failure between patients who underwent coronary-artery bypass grafting (CABG) performed with a beating-heart technique (off-pump) and those who underwent CABG performed with cardiopulmonary bypass (on-pump). We now report the results at 5 years (the end of the trial). METHODS: A total of 4752 patients (from 19 countries) who had coronary artery disease were randomly assigned to undergo off-pump or on-pump CABG. For this report, we analyzed a composite outcome of death, stroke, myocardial infarction, renal failure, or repeat coronary revascularization (either CABG or percutaneous coronary intervention). The mean follow-up period was 4.8 years. RESULTS: There were no significant differences between the off-pump group and the on-pump group in the rate of the composite outcome (23.1% and 23.6%, respectively; hazard ratio with off-pump CABG, 0.98; 95% confidence interval [CI], 0.87 to 1.10; P=0.72) or in the rates of the components of the outcome, including repeat coronary revascularization, which was performed in 2.8% of the patients in the off-pump group and in 2.3% of the patients in the on-pump group (hazard ratio, 1.21; 95% CI, 0.85 to 1.73; P=0.29). The secondary outcome for the overall period of the trial - the mean cost in U.S. dollars per patient - also did not differ significantly between the off-pump group and the on-pump group ($15,107 and $14,992, respectively; between-group difference, $115; 95% CI, -$697 to $927). There were no significant between-group differences in quality-of-life measures. CONCLUSIONS: In our trial, the rate of the composite outcome of death, stroke, myocardial infarction, renal failure, or repeat revascularization at 5 years of follow-up was similar among patients who underwent off-pump CABG and those who underwent on-pump CABG. (Funded by the Canadian Institutes of Health Research; CORONARY ClinicalTrials.gov number, NCT00463294 .).