Performing coronary artery bypass grafting off-pump may compromise long-term survival in a veteran population

Faisal G. Bakaeen, Danny Chu, Rosemary F. Kelly, Herbert B. Ward, Michael E. Jessen, G. John Chen, Nancy J. Petersen, William L. Holman

Research output: Contribution to journalArticlepeer-review

41 Scopus citations

Abstract

Background: There are ample data regarding the short-term outcomes of on-pump and off-pump coronary artery bypass grafting (CABG), but little is known about the long-term survival associated with these approaches. Methods: Using the Veterans Affairs (VA) Continuous Improvement in Cardiac Surgery Program, we identified all VA patients (n = 65,097) who underwent primary isolated CABG from October 1997 to April 2011. The primary outcome measure was all-cause mortality. Age, 17 preoperative risk factors, and year of operation were used to calculate propensity scores for each patient. A greedy-match algorithm using the propensity scores matched 8,911 off-pump with 26,733 on-pump patients. Survival functions were estimated by the Kaplan-Meier method and compared by using the log-rank test. Results: In the complete cohort, off-pump was used in 11,629 of 65,097 (17.9%) operations. For the matched cohort, the median follow-up was 6.7 years (interquartile range, 3.72 to 9.35 years). Risk-adjusted mortality did not differ significantly between the off-pump and on-pump groups at 1 year (4.67% vs 4.78%; risk ratio [RR], 0.98; 95% confidence interval [CI], 0.88 to 1.09) or 3 years (9.21% vs 8.89%; RR, 1.04; 95% CI, 0.96 to 1.12). However, risk-adjusted mortality was higher in the off-pump group at 5 years (14.47% vs 13.45%; RR, 1.08; 95% CI 1.02 to 1.15) and 10 years (25.18% vs 23.57%; RR, 1.07; 95% CI, 1.03 to 1.12). Overall, the hazard ratio for off-pump vs on-pump was 1.06 (95% CI, 1.00 to 1.13; p = 0.04). Conclusions: Off-pump CABG may be associated with decreased long-term survival. Further studies are needed to identify the reasons behind this finding.

Original languageEnglish (US)
Pages (from-to)1952-1960
Number of pages9
JournalAnnals of Thoracic Surgery
Volume95
Issue number6
DOIs
StatePublished - Jun 2013

Bibliographical note

Funding Information:
The CICSP-X study was initially funded by VA Health Services Research and Development Grant No. IHY 99214-1 (Dr Shroyer, Principal Investigator), with ongoing support from the Office of Patient Care Services, VA Central Office , Washington, D.C. This project was partly supported by the Offices of Research and Development at the Northport and Eastern Colorado Health Care System Denver Veterans Affairs Medical Centers and by the Houston VA Health Services Research and Development Service Center of Excellence ( HFP90-020 ). Special acknowledgment is given to Randy Johnson, Lisa Schade, and Missy Bell, the team members responsible for the CICSP-X access to care report sections, working under the leadership of Dr Gerald McDonald (VA Central Office).

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