Off-Pump, On-Pump CABG Produce Similar Outcomes at 5 Years in CORONARY

Larry Hand

October 25, 2016

HAMILTON, ON — Patients who undergo off-pump CABG and patients who undergo on-pump CABG experience similar outcomes at 5-year follow-up of the CABG Off or On Pump Revascularization Study (CORONARY), according to new research[1].

The 5-year results were similar to 30-day results previously reported.

"Both techniques are effective and safe," Dr André Lamy (McMaster University) told heartwire from Medscape in a telephone interview.

Lamy and colleagues analyzed data on 4752 patients from 19 countries who were randomized to undergo off-pump or on-pump CABG for the composite end point of death, stroke, MI, renal failure, or repeat revascularization during a mean follow-up of 4.8 years.

The results were published online October 23, 2016 in the New England Journal of Medicine.

The researchers found no significant differences between the off-pump and on-pump groups in the rate of the composite outcome (23.1% vs 23.6%, respectively); the hazard ratio for off-pump CABG was 0.98 (95% CI 0.87–1.10; P=0.72). They also found no significant difference in the rate of the individual components. Repeat revascularization was 2.8% in off-pump group vs 2.3% in the on-pump group (HR 1.21; 95% CI 0.85–1.73; P=0.29).

For the secondary end point of mean total cost in US dollars, the researchers also found no between-group differences ($15,107 off-pump vs $14,992 on-pump, between-group difference $115; 95% CI -$697 to $927).

Of 2845 patients who agreed to a substudy on quality of life, both groups experienced a small decline upon discharge but an increase at 30 days that was sustained throughout the trial.

Lamy told heartwire that CORONARY is the largest trial to date comparing off-pump and on-pump CABG, and "it proves that we need to do these large trials with long follow-up. We get real answers to a lot of questions."

In a subgroup analysis, the researchers found that patients with diabetes in the on-pump group had a higher incidence of the composite outcome of death, nonfatal stroke, nonfatal MI, nonfatal new renal failure requiring dialysis, or repeat coronary revascularization (22.7% off-pump vs 26.5% on-pump; HR 0.85, 95% CI 0.72–1.01; P=0.06).

"There's a signal that seems to show that off-pump with diabetic patients has a reduction in stroke, which is quite important," Lamy said. "On the other side, on-pump seems to have benefit for the nondiabetic patient in terms of survival. Diabetic and nondiabetic patients don't seem to behave the same way. We need to do further analysis."

The Canadian Institutes of Health funded the research. Lamy reported no other relevant relationships. Disclosures for the coauthors are listed on the journal website.

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