Impact of on-pump and off-pump coronary artery bypass grafting on 10-year mortality versus percutaneous coronary intervention
Author:
Kageyama Shigetaka1ORCID, Serruys Patrick W12ORCID, Ninomiya Kai1, O’Leary Neil1, Masuda Shinichiro1, Kotoku Nozomi1, Colombo Antonio34, van Geuns Robert-Jan5, Milojevic Milan67ORCID, Mack Michael J8, Soo Alan9, Garg Scot10ORCID, Onuma Yoshinobu1, Davierwala Piroze M111213, Casselman Filip, de Bruyne Bernard, Christiansen Evald Høj, Ruiz-Nodar Juan M, Vermeersch Paul, Schultz Werner, Sabaté Manel, Guagliumi Giulio, Grubitzsch Herko, Stangl Karl, Darremont Olivier, Bentala M, den Heijer Peter, Preda Istvan, Stoler Robert, Mack Michael J, Szerafin Tamás, Buckner John K, Guber Myles S, Verberkmoes Niels, Akca Ferdi, Feldman Ted, Beyersdorf Friedhelm, Drieghe Benny, Oldroyd Keith, Berg Geoff, Jeppsson Anders, Barber Kimberly, Wolschleger Kevin, Heiser John, van der Harst Pim, Mariani Massimo A, Reichenspurner Hermann, Stark Christoffer, Laine Mika, Ho Paul C, Chen John C, Zelman Richard, Horwitz Phillip A, Bochenek Andrzej, Krauze Agata, Grothusen Christina, Dudek Dariusz, Heyrich George, Davierwala Piroze, Noack Thilo, Kolh Philippe, LeGrand Victor, Coelho Pedro, Ensminger Stephan, Nasseri Boris, Ingemansson Richard, Olivecrona Goran, Escaned Javier, Guera Reddy, Berti Sergio, Morice Marie-Claude, Chieffo Alaide, Burke Nicholas, Mooney Michael, Spolaor Alvise, Hagl Christian, Näbauer Michael, Jan Suttorp Maarten, Stine Ronald A, McGarry Thomas, Lucas Scott, Endresen Knut, Taussig Andrew, Accola Kevin, Canosi Umberto, Horvath Ivan, Cannon Louis, Talbott John D, Akins Chris W, Kramer Robert, Aschermann Michael, Killinger William, Narbute Inga, Holmes David R, Burzotta Francesco, Bogers Ad, Zijlstra Felix, Eltchaninoff Helene, Berland Jacques, Stefanini Giulio, Gonzalez Ignacio Cruz, Hoppe Uta, Kiesz Stefan, Gora Bartlomiej, Ahlsson Anders, Corbascio Matthias, Bilfinger Thomas, Carrie Didier, Tchétché Didier, Hauptman Karl-Eugen, Stahle Elisabeth, James Stefan, Sandner Sigrid, Laufer Günther, Lang Irene, Witkowski Adam, Thourani Vinod, Suryapranata Harry, Redwood Simon, Knight Charles, MacCarthy Philip, Curzen Nick, de Belder Adam, Banning Adrian, Gershlick Anthony,
Affiliation:
1. Department of Cardiology, National University of Ireland, Galway (NUIG) , Galway, Ireland 2. National Heart and Lung Institute, Imperial College London , London, UK 3. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele , Milan, Italy 4. Humanitas Clinical and Research Centre IRCCS , Milan, Italy 5. Department of Cardiology, Radboud University Medical Centre , Nijmegen, Netherlands 6. Department of Cardiothoracic Surgery, Erasmus University Medical Centre , Rotterdam, Netherlands 7. Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute , Belgrade, Serbia 8. Department of Cardiothoracic Surgery, Baylor University Medical Center , Dallas, TX, USA 9. Department of Cardiothoracic Surgery, University Hospital Galway , Galway, Ireland 10. Department of Cardiology, Royal Blackburn Hospital , Blackburn, UK 11. Department of Surgery, University of Toronto , Toronto, ON, Canada 12. Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital , Toronto, ON, Canada 13. University Health Network , Toronto, ON, Canada
Abstract
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.
Funder
German Foundation of Heart Research
Publisher
Oxford University Press (OUP)
Subject
Cardiology and Cardiovascular Medicine,Pulmonary and Respiratory Medicine,General Medicine,Surgery
Cited by
3 articles.
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