Five-year outcomes of off and on-pump CABG: Insights from PROMOTE Patency Trial.

IF 0.7 Q3 Medicine ASIAN CARDIOVASCULAR & THORACIC ANNALS Pub Date : 2023-10-01 Epub Date: 2023-08-25 DOI:10.1177/02184923231197642

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

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Abstract

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.

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泵外和泵内冠状动脉搭桥术的五年结果：PROMOTE专利试验的见解。

背景：关于非体外循环冠状动脉搭桥术（OPCAB）和体外循环冠状血管搭桥术（ONCAB）技术的随访结果数据的报道有限。本研究的目的是在PROMOTE通畅性试验的事后分析中报告OPCAB和ONCAB的5年临床结果。方法：从2016年3月到2017年3月，共有321名接受冠状动脉搭桥术（CABG）的患者被随机分为非体外循环或体外循环技术。记录全因死亡率、心肌梗死（MI）、脑血管意外（CVA）、重复血运重建和需要肾脏替代治疗（RRT）的数据。综合结果和每一个单独的结果每隔5年报告一次。结果：平均随访时间为65.9个月（±3.39），共有275例（85.93%）患者在5年内接受了非体外循环冠状动脉旁路移植术（n = 158）和开泵（n = 162）技术。ONCAB和OPCAB的全因死亡率分别为8.9%和5.7%（危险比[HR] = 0.62；95%置信区间[CI]0.25-1.57，p = 0.31）。两组的全因死亡率、非致命性心肌梗死、非致命CVA、RRT和需要重复血运重建的复合因素具有可比性（7.1%vs.11.9%，HR = 0.57；95%置信区间0.25-1.31，p = OPCAB和ONCAB分别为0.18）。5年非致命性心肌梗死的发生率（p = 0.2），非致命性CVA（p = 0.36）和需要重复血运重建（p = 1）在两组中相似。亚组分析未显示与任何一种技术有任何显著的相互作用或效果改变。结论：在接受CABG的低风险患者中，OPCAB的5年临床结果与ONCAB相当。非体外循环冠状动脉搭桥术在任何亚组中都没有额外的益处。

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ASIAN CARDIOVASCULAR & THORACIC ANNALS Multiple-

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1.30

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期刊介绍： The Asian Cardiovascular and Thoracic Annals is an international peer-reviewed journal pertaining to cardiovascular and thoracic medicine. Besides original clinical manuscripts, we welcome research reports, product reviews, reports of new techniques, and findings of special significance to Asia and the Pacific Rim. Case studies that have significant novel original observations, are instructive, include adequate methodological details and provide conclusions. Workshop proceedings, meetings and book reviews, letters to the editor, and meeting announcements are encouraged along with relevant articles from authors.