No differences in on-pump versus off-pump bypass grafting at 5 years.

Coronary artery bypass grafting (CABG) may significantly improve quality of life and longevity.  As with all therapies, however, these benefits must be weighed against potential risks. Some hypothesize that aortic cross clamping and cardiopulmonary bypass, historically utilized during CABG, increase the potential for certain complications and can be successfully avoided with newer “off-pump” CABG techniques.  Various studies have examined the benefits of off-pump vs. on-pump CABG with the largest to date being the international, multi-center, randomized CABG Off or On Pump Revascularization Study (CORONARY)  study, involving 4,752 patients.  The previously reported 30 day and 1 year data from this study demonstrated no difference between techniques, but here the 5-year data are published.   Using a composite outcome of death, stroke, myocardial infarction, renal failure, or repeat coronary revascularization, there was no difference between the two surgical techniques (23.1% vs. 23.6%, P=0.72) or indeed, in any of the individuals components of the outcome.  There were also no significant between-group differences in quality-of-life measures.  A secondary analysis of economic cost also found no significant difference between the two modalities (US$15,107 vs. US$14,992).

Conclusions

This very large trial of on-pump vs off–pump CABG demonstrates no difference in any measured outcome at either short or long-term follow-up.  Both techniques would appear to be equally safe and efficacious.

Lamy A, Devereaux PJ, Prabhakaran D, Taggart DP, Hu S, Straka Z, Piegas LS, Avezum A, Akar AR, Lanas Zanetti F, Jain AR, Noiseux N, Padmanabhan C, Bahamondes JC, Novick RJ, Tao L, Olavegogeascoechea PA, Airan B, Sulling TA, Whitlock RP, Ou Y, Gao P, Pettit S, Yusuf S; CORONARY Investigators. Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting. N Engl J Med. 2016 Dec 15;375(24):2359-2368.

 

Hussain Contractor and James M. McCabe