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N Engl J Med. 2012 Apr 19;366(16):1489-97. doi: 10.1056/NEJMoa1200388. Epub 2012 Mar 26.

Off-pump or on-pump coronary-artery bypass grafting at 30 days.

Collaborators (248)

Yusuf S, Taggart DP, Lamy A, Akar AR, Avezum A, Cartier R, Chocron S, Chrolavicius S, Devereaux P, Prabhakaran D, Fremes SE, Hu S, Lanas F, Lopez PJ, Martinelli L, Murkin J, Novick RJ, Paolasso E, Piegas L, Straka Z, Cairns JA, Dagenais F, Follmann D, Nathan HJ, Silver FL, Avezum A, Botto F, Dyub A, Fodor G, Healey J, Jolly S, Lawrence M, Lurati G, Malikov K, Morillo C, Chrolavicius S, Ou Y, Jedrzejowski B, Lawrence M, Floyd L, Manojlovic R, Ng J, Pasadyn E, Pogue J, Robinson L, Vincent J, Lamy A, Devereaux PJ, Whitlock R, Yusuf S, Abud JA, Aventín G, Cacheda H, Casal JP, Collantes JA, Escarain MC, Favaloro RR, Ferrara WD, Giner PE, Girela AG, Olavegogeascoechea PA, Quiroga JM, Raffaelli HA, Valenzuela G, Bannon PG, Vallely MP, Barros RT, Braile DM, Buffolo E, Chamlian EG, Costa FD, Sales Mde C, de Oliveira BC, de Oliveira JB, de Rueda F, de Sousa LC, Farsky P, Ferreira AD, Frota JD, Stolf NA, Guilhen JC, Hueb AC, Hueb W, Issa M, Jatene FB, Leal JC, Lima R, Lucchese FA, Moraes C, Moraes F, Muzio H, Freitas AC, Penna AC, Pires AC, Rivetti LA, Rösler AM, Seixas LE, Nova DC, Smith P, Basile F, Cartier R, Cheung AW, Cusimano RJ, Dyub A, Esmaeili N, Fox SA, Fremes SE, Greentree DM, Guo L, Kiaii B, Kieser TM, Lamy A, Moussa F, Noiseux N, Normandin L, Novick RJ, Perrault LP, Prieto I, Rizzo T, Stevens LM, Toito F, Yau TM, Ye J, Bahamondes JC, Meriño GH, Salman JA, Silva AA, Villavicencio MA, An X, Chen X, Chen X, Gao C, Gu S, Gu T, Hu S, Kong Y, Lai H, Liu Y, Meng X, Pan X, Su P, Sun X, Tang H, Tao L, Wang C, Wang C, Wang L, Wang R, Wang W, Wang Y, Wu Y, Xia L, Xu M, Xue S, Yang J, Yi D, Yu H, Zhang H, Zhao Q, Zheng Z, Zhou H, Zhou X, Borrero AJ, Cadavid EA, Castillo VR, Chalela T, Figueredo A, Machuca AS, Sandoval NF, Brat R, Danek T, Harrer J, Hlavicka J, Holubcova Z, Holubec T, Jelinek S, Mikulenka V, Setina M, Straka Z, Vanek T, Vik K, Zacek P, Alver M, Sulling TA, Vähi H, Chocron S, Kaili D, Agarwal SK, Airan B, Arunachalam KV, Ayapati DR, Choudhary SK, Ganesh SB, Gokhale AG, Gupta VM, Hote MP, Jain AR, Kaul U, Reddy S, Malipeddi BR, Mallya BS, Mishra YK, Modi RV, Mohammed AP, Nair SK, Padhy K, Padmanabhan C, Pande S, Podduturi Naveen CR, Ponangi SV, Reddy SK, Sinha N, Srinivasan M, Sundar A, Thomas MS, Vaijyanath P, Vettath MP, Kavita, Agostini M, Di Gregorio V, Martinelli L, Pelenghi S, Bentala M, Arbeus MJ, De Souza DR, Akar AR, Aykut Aka S, Baran C, Durdu S, Hidiroglu M, Kahraman D, Kaya K, Sener E, Sinci V, Uguz E, Zaim C, Gogayeva O, Rudenko A, Birdi I, Lloyd S, Ritchie AJ, Taggart DP, Zamvar V, Chafes D, Montaña O, Huang KF, Parvathaneni SV, Tourville RL.

Author information

  • 1Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada. lamya@mcmaster.ca

Abstract

BACKGROUND:

The relative benefits and risks of performing coronary-artery bypass grafting (CABG) with a beating-heart technique (off-pump CABG), as compared with cardiopulmonary bypass (on-pump CABG), are not clearly established.

METHODS:

At 79 centers in 19 countries, we randomly assigned 4752 patients in whom CABG was planned to undergo the procedure off-pump or on-pump. The first coprimary outcome was a composite of death, nonfatal stroke, nonfatal myocardial infarction, or new renal failure requiring dialysis at 30 days after randomization.

RESULTS:

There was no significant difference in the rate of the primary composite outcome between off-pump and on-pump CABG (9.8% vs. 10.3%; hazard ratio for the off-pump group, 0.95; 95% confidence interval [CI], 0.79 to 1.14; P=0.59) or in any of its individual components. The use of off-pump CABG, as compared with on-pump CABG, significantly reduced the rates of blood-product transfusion (50.7% vs. 63.3%; relative risk, 0.80; 95% CI, 0.75 to 0.85; P<0.001), reoperation for perioperative bleeding (1.4% vs. 2.4%; relative risk, 0.61; 95% CI, 0.40 to 0.93; P=0.02), acute kidney injury (28.0% vs. 32.1%; relative risk, 0.87; 95% CI, 0.80 to 0.96; P=0.01), and respiratory complications (5.9% vs. 7.5%; relative risk, 0.79; 95% CI, 0.63 to 0.98; P=0.03) but increased the rate of early repeat revascularizations (0.7% vs. 0.2%; hazard ratio, 4.01; 95% CI, 1.34 to 12.0; P=0.01).

CONCLUSIONS:

There was no significant difference between off-pump and on-pump CABG with respect to the 30-day rate of death, myocardial infarction, stroke, or renal failure requiring dialysis. The use of off-pump CABG resulted in reduced rates of transfusion, reoperation for perioperative bleeding, respiratory complications, and acute kidney injury but also resulted in an increased risk of early revascularization. (Funded by the Canadian Institutes of Health Research; CORONARY ClinicalTrials.gov number, NCT00463294.).

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PMID:
22449296
[PubMed - indexed for MEDLINE]
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