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Randomized Controlled Trial
. 2016 Dec 15;375(24):2359-2368.
doi: 10.1056/NEJMoa1601564. Epub 2016 Oct 23.

Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting

André Lamy  1 , P J Devereaux  1 , Dorairaj Prabhakaran  1 , David P Taggart  1 , Shengshou Hu  1 , Zbynek Straka  1 , Leopoldo S Piegas  1 , Alvaro Avezum  1 , Ahmet R Akar  1 , Fernando Lanas Zanetti  1 , Anil R Jain  1 , Nicolas Noiseux  1 , Chandrasekar Padmanabhan  1 , Juan-Carlos Bahamondes  1 , Richard J Novick  1 , Liang Tao  1 , Pablo A Olavegogeascoechea  1 , Balram Airan  1 , Toomas-Andres Sulling  1 , Richard P Whitlock  1 , Yongning Ou  1 , Peggy Gao  1 , Shirley Pettit  1 , Salim Yusuf  1 ; CORONARY Investigators
Collaborators, Affiliations
Free article
Randomized Controlled Trial

Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting

André Lamy et al. N Engl J Med. .
Free article

Abstract

Background: We previously reported that there was no significant difference at 30 days or at 1 year in the rate of the composite outcome of death, stroke, myocardial infarction, or renal failure 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 the results at 5 years (the end of the trial).

Methods: A total of 4752 patients (from 19 countries) who had coronary artery disease were randomly assigned to undergo off-pump or on-pump CABG. For this report, we analyzed a composite outcome of death, stroke, myocardial infarction, renal failure, or repeat coronary revascularization (either CABG or percutaneous coronary intervention). The mean follow-up period was 4.8 years.

Results: There were no significant differences between the off-pump group and the on-pump group in the rate of the composite outcome (23.1% and 23.6%, respectively; hazard ratio with off-pump CABG, 0.98; 95% confidence interval [CI], 0.87 to 1.10; P=0.72) or in the rates of the components of the outcome, including repeat coronary revascularization, which was performed in 2.8% of the patients in the off-pump group and in 2.3% of the patients in the on-pump group (hazard ratio, 1.21; 95% CI, 0.85 to 1.73; P=0.29). The secondary outcome for the overall period of the trial - the mean cost in U.S. dollars per patient - also did not differ significantly between the off-pump group and the on-pump group ($15,107 and $14,992, respectively; between-group difference, $115; 95% CI, -$697 to $927). There were no significant between-group differences in quality-of-life measures.

Conclusions: In our trial, the rate of the composite outcome of death, stroke, myocardial infarction, renal failure, or repeat revascularization at 5 years of follow-up was similar among patients who underwent off-pump CABG and those who underwent on-pump CABG. (Funded by the Canadian Institutes of Health Research; CORONARY ClinicalTrials.gov number, NCT00463294 .).

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