Current Status of Off-pump Coronary Artery Bypass Grafting in Patients with Multiple Coronary Artery Disease Compared with On-pump Coronary Artery Bypass Grafting

The Korean National Cohort Study

Hee Jung Kim, Jae Eun Chung, Jae-Seung Jung, In Seup Kim, Ho Sung Son

Research output: Contribution to journalArticle

Abstract

Background Despite advance in off-pump coronary artery bypass (OPCAB) grafting, there are large debating issues regarding survival benefit between OPCAB and on-pump coronary artery bypass grafting (CABG). The aim of this study is to address appropriateness of OPCAB approach in patients with ischemic heart disease having multiple vessels using South Korea national cohort data. Methods To evaluate the safety and efficacy of OPCAB, we accessed all causes of death, late repeat revascularization, hospitalization for cerebrovascular accident (CVA), and new renal replacement therapy in patients who underwent isolated CABG with multiple grafting (≥2 grafts) and who were registered in the Korean Health Insurance Review and Assessment Service Database between April 2011 and September 2014. Results OPCAB was performed in 4,692 patients and on-pump CABG in 2,999 patients from 82 hospitals in South Korea. On multivariable analysis, on–pump CABG was associated with a significantly higher adjusted risk of overall all-cause death (hazard ratio [HR]: 1.876, 95% confidence interval [CI]: 1.587–2.216, p < 0.001) and initiation of new renal replacement therapy (HR: 1.618, 95% CI: 1.124–2.331, p = 0.009). However, we observed no significant difference in repeat revascularization and hospitalization for CVA between the two groups. In propensity score matching, matched patients (2,940 pairs) showed results similar to multivariable analysis that on-pump CABG was associated with a higher overall mortality and initiation of new renal replacement therapy ( p < 0.001). Conclusion In this study, we found that OPCAB was associated with better survival rates and renal preservation compared with on-pump CABG.

Original languageEnglish
JournalThoracic and Cardiovascular Surgeon
DOIs
Publication statusAccepted/In press - 2018 May 31

Fingerprint

Off-Pump Coronary Artery Bypass
Coronary Artery Bypass
Coronary Artery Disease
Cohort Studies
Renal Replacement Therapy
Republic of Korea
Cause of Death
Hospitalization
Stroke
Confidence Intervals
Propensity Score
Health Insurance
Myocardial Ischemia
Survival Rate
Databases
Transplants
Kidney
Safety
Survival
Mortality

Keywords

  • coronary artery bypass grafting
  • off-pump coronary artery bypass grafting
  • registries

ASJC Scopus subject areas

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

Cite this

@article{6304c579cd4149498a1bea92f20dae8b,
title = "Current Status of Off-pump Coronary Artery Bypass Grafting in Patients with Multiple Coronary Artery Disease Compared with On-pump Coronary Artery Bypass Grafting: The Korean National Cohort Study",
abstract = "Background Despite advance in off-pump coronary artery bypass (OPCAB) grafting, there are large debating issues regarding survival benefit between OPCAB and on-pump coronary artery bypass grafting (CABG). The aim of this study is to address appropriateness of OPCAB approach in patients with ischemic heart disease having multiple vessels using South Korea national cohort data. Methods To evaluate the safety and efficacy of OPCAB, we accessed all causes of death, late repeat revascularization, hospitalization for cerebrovascular accident (CVA), and new renal replacement therapy in patients who underwent isolated CABG with multiple grafting (≥2 grafts) and who were registered in the Korean Health Insurance Review and Assessment Service Database between April 2011 and September 2014. Results OPCAB was performed in 4,692 patients and on-pump CABG in 2,999 patients from 82 hospitals in South Korea. On multivariable analysis, on–pump CABG was associated with a significantly higher adjusted risk of overall all-cause death (hazard ratio [HR]: 1.876, 95{\%} confidence interval [CI]: 1.587–2.216, p < 0.001) and initiation of new renal replacement therapy (HR: 1.618, 95{\%} CI: 1.124–2.331, p = 0.009). However, we observed no significant difference in repeat revascularization and hospitalization for CVA between the two groups. In propensity score matching, matched patients (2,940 pairs) showed results similar to multivariable analysis that on-pump CABG was associated with a higher overall mortality and initiation of new renal replacement therapy ( p < 0.001). Conclusion In this study, we found that OPCAB was associated with better survival rates and renal preservation compared with on-pump CABG.",
keywords = "coronary artery bypass grafting, off-pump coronary artery bypass grafting, registries",
author = "Kim, {Hee Jung} and Chung, {Jae Eun} and Jae-Seung Jung and Kim, {In Seup} and Son, {Ho Sung}",
year = "2018",
month = "5",
day = "31",
doi = "10.1055/s-0038-1651516",
language = "English",
journal = "Thoracic and Cardiovascular Surgeon",
issn = "0171-6425",
publisher = "Georg Thieme Verlag",

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TY - JOUR

T1 - Current Status of Off-pump Coronary Artery Bypass Grafting in Patients with Multiple Coronary Artery Disease Compared with On-pump Coronary Artery Bypass Grafting

T2 - The Korean National Cohort Study

AU - Kim, Hee Jung

AU - Chung, Jae Eun

AU - Jung, Jae-Seung

AU - Kim, In Seup

AU - Son, Ho Sung

PY - 2018/5/31

Y1 - 2018/5/31

N2 - Background Despite advance in off-pump coronary artery bypass (OPCAB) grafting, there are large debating issues regarding survival benefit between OPCAB and on-pump coronary artery bypass grafting (CABG). The aim of this study is to address appropriateness of OPCAB approach in patients with ischemic heart disease having multiple vessels using South Korea national cohort data. Methods To evaluate the safety and efficacy of OPCAB, we accessed all causes of death, late repeat revascularization, hospitalization for cerebrovascular accident (CVA), and new renal replacement therapy in patients who underwent isolated CABG with multiple grafting (≥2 grafts) and who were registered in the Korean Health Insurance Review and Assessment Service Database between April 2011 and September 2014. Results OPCAB was performed in 4,692 patients and on-pump CABG in 2,999 patients from 82 hospitals in South Korea. On multivariable analysis, on–pump CABG was associated with a significantly higher adjusted risk of overall all-cause death (hazard ratio [HR]: 1.876, 95% confidence interval [CI]: 1.587–2.216, p < 0.001) and initiation of new renal replacement therapy (HR: 1.618, 95% CI: 1.124–2.331, p = 0.009). However, we observed no significant difference in repeat revascularization and hospitalization for CVA between the two groups. In propensity score matching, matched patients (2,940 pairs) showed results similar to multivariable analysis that on-pump CABG was associated with a higher overall mortality and initiation of new renal replacement therapy ( p < 0.001). Conclusion In this study, we found that OPCAB was associated with better survival rates and renal preservation compared with on-pump CABG.

AB - Background Despite advance in off-pump coronary artery bypass (OPCAB) grafting, there are large debating issues regarding survival benefit between OPCAB and on-pump coronary artery bypass grafting (CABG). The aim of this study is to address appropriateness of OPCAB approach in patients with ischemic heart disease having multiple vessels using South Korea national cohort data. Methods To evaluate the safety and efficacy of OPCAB, we accessed all causes of death, late repeat revascularization, hospitalization for cerebrovascular accident (CVA), and new renal replacement therapy in patients who underwent isolated CABG with multiple grafting (≥2 grafts) and who were registered in the Korean Health Insurance Review and Assessment Service Database between April 2011 and September 2014. Results OPCAB was performed in 4,692 patients and on-pump CABG in 2,999 patients from 82 hospitals in South Korea. On multivariable analysis, on–pump CABG was associated with a significantly higher adjusted risk of overall all-cause death (hazard ratio [HR]: 1.876, 95% confidence interval [CI]: 1.587–2.216, p < 0.001) and initiation of new renal replacement therapy (HR: 1.618, 95% CI: 1.124–2.331, p = 0.009). However, we observed no significant difference in repeat revascularization and hospitalization for CVA between the two groups. In propensity score matching, matched patients (2,940 pairs) showed results similar to multivariable analysis that on-pump CABG was associated with a higher overall mortality and initiation of new renal replacement therapy ( p < 0.001). Conclusion In this study, we found that OPCAB was associated with better survival rates and renal preservation compared with on-pump CABG.

KW - coronary artery bypass grafting

KW - off-pump coronary artery bypass grafting

KW - registries

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U2 - 10.1055/s-0038-1651516

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JO - Thoracic and Cardiovascular Surgeon

JF - Thoracic and Cardiovascular Surgeon

SN - 0171-6425

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