Off-Pump vs. On-Pump CABG at 5 Years

Authors: Lamy A et al., N Engl J Med 2016 Oct 23;

Data on outcomes, cost, and quality of life did not differ significantly between the two coronary artery bypass grafting strategies.

In the multinational, randomized CORONARY trial, comparing off-pump (beating heart) with on-pump coronary artery bypass grafting (CABG), the primary endpoint did not differ significantly between the two groups at 30 days or at 1 year (NEJM JW Cardiol Apr 2013)and N Engl J Med 2013; 368:1179). Researchers now report longer-term follow-up data for the 4752 trial participants.

At a mean follow-up of 4.8 years, the two groups did not differ significantly in the composite endpoint of death, stroke, myocardial infarction, renal failure, or repeat coronary revascularization (off-pump, 23.1%; on-pump, 23.6%), in any of the individual endpoint components, or in mean cost per patient. The primary outcome was also similar between the two groups specifically for the period between 1 year and 4.8 years of follow-up. No prespecified subgroups fared significantly better with one type of CABG versus the other. Quality-of-life measures, assessed in 60% of trial participants, did not differ significantly between the off-pump and on-pump groups.

Comment This large randomized trial revealed no significant differences between off-pump and on-pump CABG in outcomes, cost, or quality of life. The findings underscore the importance of thoroughly evaluating new surgical techniques before adopting them widely. The choice between off-pump and on-pump CABG is a decision for individual surgeons and their patients.