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 journalArticle

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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

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Veterans
Coronary Artery Bypass
Confidence Intervals
Odds Ratio
Survival
Off-Pump Coronary Artery Bypass
Propensity Score
Population
Mortality
Thoracic Surgery
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

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Performing coronary artery bypass grafting off-pump may compromise long-term survival in a veteran population. / Bakaeen, Faisal G.; Chu, Danny; Kelly, Rosemary F.; Ward, Herbert B.; Jessen, Michael E; Chen, G. John; Petersen, Nancy J.; Holman, William L.

In: Annals of Thoracic Surgery, Vol. 95, No. 6, 06.2013, p. 1952-1960.

Research output: Contribution to journalArticle

Bakaeen, Faisal G. ; Chu, Danny ; Kelly, Rosemary F. ; Ward, Herbert B. ; Jessen, Michael E ; Chen, G. John ; Petersen, Nancy J. ; Holman, William L. / Performing coronary artery bypass grafting off-pump may compromise long-term survival in a veteran population. In: Annals of Thoracic Surgery. 2013 ; Vol. 95, No. 6. pp. 1952-1960.
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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.",
author = "Bakaeen, {Faisal G.} and Danny Chu and Kelly, {Rosemary F.} and Ward, {Herbert B.} and Jessen, {Michael E} and Chen, {G. John} and Petersen, {Nancy J.} and Holman, {William L.}",
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T1 - Performing coronary artery bypass grafting off-pump may compromise long-term survival in a veteran population

AU - Bakaeen, Faisal G.

AU - Chu, Danny

AU - Kelly, Rosemary F.

AU - Ward, Herbert B.

AU - Jessen, Michael E

AU - Chen, G. John

AU - Petersen, Nancy J.

AU - Holman, William L.

PY - 2013/6

Y1 - 2013/6

N2 - 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.

AB - 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.

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