Five-year outcomes of off and on-pump CABG: Insights from PROMOTE Patency Trial
Lokeswara Rao Sajja, Kunal Sarkar, Gopichand Mannam, Chandrasekhar Padmanabhan, Pradeep Narayan, Devanish NH Kamtam, Nagalla Balakrishna, Venkata Krishna Kumar Kodali, Anvay Mulay, Sanjeeth Peter, Prashanthi Beri- Cardiology and Cardiovascular Medicine
- Pulmonary and Respiratory Medicine
- General Medicine
- Surgery
Background
There are limited studies reporting follow-up outcome data comparing of off-pump coronary artery bypass (OPCAB) with on-pump (ONCAB) technique. The aim of the study was to report the 5-year clinical outcomes of OPCAB and ONCAB in a post hoc analysis of the PROMOTE patency trial.
Methods
From March 2016 through March 2017, a total of 321 patients undergoing coronary artery bypass grafting (CABG) were randomised to either the off-pump or the on-pump technique. Data on all-cause mortality, myocardial infarction (MI), cerebrovascular accident (CVA), repeat revascularisation and need for renal replacement therapy (RRT) were recorded. The composite and each of these individual outcomes are reported at 5-year interval.
Results
The mean follow-up period was 65.9 months (±3.39). A total of 275 (85.93%) patients followed up at the 5-year interval who underwent CABG by the off-pump ( n = 158) and the on-pump ( n = 162) technique. The all-cause mortality was 8.9% and 5.7% in ONCAB and OPCAB, respectively (hazard ratio [HR] = 0.62; 95% confidence interval [CI] 0.25–1.57, p = 0.31). The composite of all-cause mortality, non-fatal MI, non-fatal CVA, RRT and need for repeat revascularisation was comparable in both groups (7.1% vs. 11.9%, HR = 0.57; 95% CI 0.25–1.31, p = 0.18 in OPCAB and ONCAB, respectively). The rates of 5-year non-fatal MI ( p = 0.2), non-fatal CVA ( p = 0.36) and need for repeat revascularisation ( p = 1) were similar in both groups. A sub-group analysis did not show any significant interaction or effect modification with either of the techniques.
Conclusions
The 5-year clinical outcomes of OPCAB are comparable to ONCAB in low-risk patients undergoing CABG. Off-pump coronary artery bypass had no additional benefit in any subgroup.