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  • Title: Three-year follow-up in a subset of high-risk patients randomly assigned to off-pump versus on-pump coronary artery bypass surgery: the Best Bypass Surgery trial.
    Author: Møller CH, Perko MJ, Lund JT, Andersen LW, Kelbæk H, Madsen JK, Winkel P, Gluud C, Steinbrüchel DA.
    Journal: Heart; 2011 Jun; 97(11):907-13. PubMed ID: 21415073.
    Abstract:
    OBJECTIVE: To evaluate off-pump versus on-pump coronary artery bypass grafting (CABG) in patients with three-vessel disease and a high-risk operative profile. DESIGN: A randomised clinical trial. SETTING: Rigshospitalet, University Hospital, Copenhagen, Denmark. PARTICIPANTS: 341 patients with three-vessel disease and a EuroSCORE of 5 or greater. Main exclusion criteria were previous heart surgery, poor left ventricular function (ejection fraction <30%), or unstable preoperative condition. INTERVENTION: CABG performed with versus without cardiopulmonary bypass. MAIN OUTCOME MEASURE: The primary outcome was a composite of major adverse cardiac and cerebrovascular events (MACCE) including all-cause mortality, acute myocardial infarction, cardiac arrest with successful resuscitation, low cardiac output syndrome/cardiogenic shock, stroke and coronary reintervention. RESULTS: MACCE occurred in 69 (40%) patients allocated to off-pump versus 54 (33%) patients allocated to on-pump CABG during the median 3.7 years of follow-up (HR 1.22; 95% CI 0.86 to 1.75; p=0.26). All-cause mortality was significantly increased in the off-pump group (24% vs 15%; HR 1.66, 95% CI 1.02 to 2.73; p=0.04), but cardiac-related death was not significantly different (10% vs 7%; HR 1.30, 95% CI 0.64 to 2.66; p=0.47). An insignificant trend towards a reduction in myocardial infarction after off-pump CABG was observed (7% vs 14%; HR 0.53, 95% CI: 0.27 to 1.04; p=0.06). CONCLUSIONS: No significant difference in the primary outcome of MACCE was found between off-pump and on-pump CABG. However, mortality seemed higher after off-pump CABG. TRIAL REGISTRATION: http://clinicaltrials.gov/number, NCT00120991.
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