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 language | English |
|---|---|
| Journal | Thoracic and Cardiovascular Surgeon |
| DOIs | |
| Publication status | Accepted/In press - 2018 May 31 |
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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
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. / Kim, Hee Jung; Chung, Jae Eun; Jung, Jae-Seung; Kim, In Seup; Son, Ho Sung.
In: Thoracic and Cardiovascular Surgeon, 31.05.2018.Research output: Contribution to journal › Article
}
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
UR - http://www.scopus.com/inward/record.url?scp=85047987174&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85047987174&partnerID=8YFLogxK
U2 - 10.1055/s-0038-1651516
DO - 10.1055/s-0038-1651516
M3 - Article
C2 - 29852507
AN - SCOPUS:85047987174
JO - Thoracic and Cardiovascular Surgeon
JF - Thoracic and Cardiovascular Surgeon
SN - 0171-6425
ER -