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. 2023 Aug 1;64(2):ezad240.
doi: 10.1093/ejcts/ezad240.

Impact of on-pump and off-pump coronary artery bypass grafting on 10-year mortality versus percutaneous coronary intervention

Shigetaka Kageyama  1 , Patrick W Serruys  1   2 , Kai Ninomiya  1 , Neil O'Leary  1 , Shinichiro Masuda  1 , Nozomi Kotoku  1 , Antonio Colombo  3   4 , Robert-Jan van Geuns  5 , Milan Milojevic  6   7 , Michael J Mack  8 , Alan Soo  9 , Scot Garg  10 , Yoshinobu Onuma  1 , Piroze M Davierwala  11   12   13 ; SYNTAX Extended Survival Investigators
Collaborators, Affiliations

Impact of on-pump and off-pump coronary artery bypass grafting on 10-year mortality versus percutaneous coronary intervention

Shigetaka Kageyama et al. Eur J Cardiothorac Surg. .

Abstract

Objectives: The very long-term mortality of off-pump and on-pump coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in a randomized complex coronary artery disease population is unknown. This study aims to investigate the impact of on-pump and off-pump CABG versus PCI on 10-year all-cause mortality.

Methods: The SYNTAX trial randomized 1800 patients with three-vessel and/or left main coronary artery disease to PCI or CABG and assessed their survival at 10 years. In this sub-study, the hazard of mortality over 10 years was compared according to the technique of revascularization: on-pump CABG (n = 725), off-pump CABG (n = 128) and PCI (n = 903).

Results: There was substantial inter-site variation in the use of off-pump CABG despite baseline characteristics being largely homogeneous among the 3 groups. The crude rate of mortality was significantly lower following on-pump CABG versus PCI [25.6% vs 28.4%, hazard ratio (HR) 0.79, 95% confidence interval (CI) 0.65-0.96], while it was comparable between off-pump CABG and PCI (28.5% vs 28.4%, HR 0.98, 95% CI 0.69-1.40). After adjusting for the 9 variables included in the SYNTAX score II 2020, 10-year mortality remained significantly lower with on-pump CABG than PCI (HR 0.75 against PCI, P = 0.009).

Conclusions: In the SYNTAXES trial, 10-year mortality adjusted for major confounders was significantly lower following on-pump CABG compared to PCI. There was no evidence for unadjusted difference between off-pump CABG and PCI, although the unadjusted estimated HR had a wide CI. Site heterogeneity in the technique used in bypass surgery has had measurable effects on treatment performance.

Keywords: Complex coronary artery disease; Coronary artery bypass grafting; Percutaneous coronary intervention; Revascularization; Ten-year mortality.

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Figures

Figure 1:
Figure 1:
Study flowchart illustration. The sample size for the comparator groups analysed for the primary analysis was reduced slightly due to missingness in a small proportion of baseline variables used in the adjusted model. CABG: coronary artery bypass grafts; PCI: percutaneous coronary intervention.
Figure 2:
Figure 2:
Region disparity of on-pump and off-pump in SYNTAX trial. Patient number of the on-pump and off-pump CABG per institute stratified by country and region. In 4 centres with only 1 or 2 patients recruited, there was no allocation to the CABG arm as per randomization. CABG: coronary artery bypass graft.
Figure 3:
Figure 3:
Crude and adjusted survival curve of 10-year mortality. (A) Crude survival curve of 10-year mortality. Image (A) shows rude Kaplan–Meier mortality curves in 3 groups (on-pump CABG, off-pump CABG and PCI). (B) Inverse probability weighting-adjusted survival curves of on-pump CABG and PCI. Image (B) shows inverse probability weighting-adjusted survival curves of on-pump CABG and PCI. CABG: coronary artery bypass grafts; COPD: chronic obstructive pulmonary disease; EF: ejection fraction; PCI: percutaneous coronary intervention.
None
See this image and copyright information in PMC

Comment in

References

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