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Heart. 2011 Jun;97(11):907-13. doi: 10.1136/hrt.2010.211680. Epub 2011 Mar 17.

Three-year follow-up in a subset of high-risk patients randomly assigned to off-pump versus on-pump coronary artery bypass surgery: the Best Bypass Surgery trial.

Author information

  • 1Department of Cardio-Thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark. chm@ctu.rh.dk

Abstract

OBJECTIVE:

To evaluate off-pump versus on-pump coronary artery bypass grafting (CABG) in patients with three-vessel disease and a high-risk operative profile.

DESIGN:

A randomised clinical trial.

SETTING:

Rigshospitalet, University Hospital, Copenhagen, Denmark.

PARTICIPANTS:

341 patients with three-vessel disease and a EuroSCORE of 5 or greater. Main exclusion criteria were previous heart surgery, poor left ventricular function (ejection fraction <30%), or unstable preoperative condition.

INTERVENTION:

CABG performed with versus without cardiopulmonary bypass.

MAIN OUTCOME MEASURE:

The primary outcome was a composite of major adverse cardiac and cerebrovascular events (MACCE) including all-cause mortality, acute myocardial infarction, cardiac arrest with successful resuscitation, low cardiac output syndrome/cardiogenic shock, stroke and coronary reintervention.

RESULTS:

MACCE occurred in 69 (40%) patients allocated to off-pump versus 54 (33%) patients allocated to on-pump CABG during the median 3.7 years of follow-up (HR 1.22; 95% CI 0.86 to 1.75; p=0.26). All-cause mortality was significantly increased in the off-pump group (24% vs 15%; HR 1.66, 95% CI 1.02 to 2.73; p=0.04), but cardiac-related death was not significantly different (10% vs 7%; HR 1.30, 95% CI 0.64 to 2.66; p=0.47). An insignificant trend towards a reduction in myocardial infarction after off-pump CABG was observed (7% vs 14%; HR 0.53, 95% CI: 0.27 to 1.04; p=0.06).

CONCLUSIONS:

No significant difference in the primary outcome of MACCE was found between off-pump and on-pump CABG. However, mortality seemed higher after off-pump CABG.

TRIAL REGISTRATION:

http://clinicaltrials.gov/number, NCT00120991.

PMID:
21415073
[PubMed - indexed for MEDLINE]
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