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N Engl J Med. 2013 Mar 28;368(13):1179-88. doi: 10.1056/NEJMoa1301228. Epub 2013 Mar 11.

Effects of off-pump and on-pump coronary-artery bypass grafting at 1 year.

Collaborators (247)

Yusuf S, Taggart DP, Lamy A, Akar AR, Avezum A, Cartier R, Chocron S, Chrolavicius S, Devereaux P, Dorairaj P, 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, de Cunha Sales M, de Oliveira BC, de Oliveira JB, de Rueda F, de Sousa LC, Farsky P, Ferreira AD, Frota JD, Groppo Stolf NA, Guilhen JC, Hueb AC, Hueb W, Issa M, Jatene FB, Leal JC, Lima R, Lucchese FA, Moraes C, Moraes F, Muzio H, Oliveira Freitas AC, Penna AC, Pires AC, Rivetti LA, Rösler AM, Seixas LE, Vila 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, Kumar 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, 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

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

Abstract

BACKGROUND:

Previously, we reported that there was no significant difference at 30 days in the rate of a primary composite outcome of death, myocardial infarction, stroke, or new renal failure requiring dialysis 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 results on quality of life and cognitive function and on clinical outcomes at 1 year.

METHODS:

We enrolled 4752 patients with coronary artery disease who were scheduled to undergo CABG and randomly assigned them to undergo the procedure off-pump or on-pump. Patients were enrolled at 79 centers in 19 countries. We assessed quality of life and cognitive function at discharge, at 30 days, and at 1 year and clinical outcomes at 1 year.

RESULTS:

At 1 year, there was no significant difference in the rate of the primary composite outcome between off-pump and on-pump CABG (12.1% and 13.3%, respectively; hazard ratio with off-pump CABG, 0.91; 95% confidence interval [CI], 0.77 to 1.07; P=0.24). The rate of the primary outcome was also similar in the two groups in the period between 31 days and 1 year (hazard ratio, 0.79; 95% CI, 0.55 to 1.13; P=0.19). The rate of repeat coronary revascularization at 1 year was 1.4% in the off-pump group and 0.8% in the on-pump group (hazard ratio, 1.66; 95% CI, 0.95 to 2.89; P=0.07). There were no significant differences between the two groups at 1 year in measures of quality of life or neurocognitive function.

CONCLUSIONS:

At 1 year after CABG, there was no significant difference between off-pump and on-pump CABG with respect to the primary composite outcome, the rate of repeat coronary revascularization, quality of life, or neurocognitive function. (Funded by the Canadian Institutes of Health Research; CORONARY ClinicalTrials.gov number, NCT00463294.).

PMID:
23477676
DOI:
10.1056/NEJMoa1301228
[Indexed for MEDLINE]
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