Off-pump versus on-pump coronary-artery bypass grafting in elderly patients
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Off-pump versus on-pump coronary-artery bypass grafting in elderly patients. / Diegeler, Anno; Börgermann, Jochen; Kappert, Utz; Breuer, Martin; Böning, Andreas; Ursulescu, Adrian; Rastan, Ardawan; Holzhey, David; Treede, Hendrik; Rieß, Friedrich-Christian; Veeckmann, Philippe; Asfoor, Amjad; Reents, Wilko; Zacher, Michael; Hilker, Michael; GOPCABE Study Group.
in: NEW ENGL J MED, Jahrgang 368, Nr. 13, 28.03.2013, S. 1189-1198.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Off-pump versus on-pump coronary-artery bypass grafting in elderly patients
AU - Diegeler, Anno
AU - Börgermann, Jochen
AU - Kappert, Utz
AU - Breuer, Martin
AU - Böning, Andreas
AU - Ursulescu, Adrian
AU - Rastan, Ardawan
AU - Holzhey, David
AU - Treede, Hendrik
AU - Rieß, Friedrich-Christian
AU - Veeckmann, Philippe
AU - Asfoor, Amjad
AU - Reents, Wilko
AU - Zacher, Michael
AU - Hilker, Michael
AU - GOPCABE Study Group
PY - 2013/3/28
Y1 - 2013/3/28
N2 - BACKGROUND: The benefits of coronary-artery bypass grafting (CABG) without cardiopulmonary bypass in the elderly are still undetermined.METHODS: We randomly assigned patients 75 years of age or older who were scheduled for elective first-time CABG to undergo the procedure either without cardiopulmonary bypass (off-pump CABG) or with it (on-pump CABG). The primary end point was a composite of death, stroke, myocardial infarction, repeat revascularization, or new renal-replacement therapy at 30 days and at 12 months after surgery.RESULTS: A total of 2539 patients underwent randomization. At 30 days after surgery, there was no significant difference between patients who underwent off-pump surgery and those who underwent on-pump surgery in terms of the composite outcome (7.8% vs. 8.2%; odds ratio, 0.95; 95% confidence interval [CI], 0.71 to 1.28; P=0.74) or four of the components (death, stroke, myocardial infarction, or new renal-replacement therapy). Repeat revascularization occurred more frequently after off-pump CABG than after on-pump CABG (1.3% vs. 0.4%; odds ratio, 2.42; 95% CI, 1.03 to 5.72; P=0.04). At 12 months, there was no significant between-group difference in the composite end point (13.1% vs. 14.0%; hazard ratio, 0.93; 95% CI, 0.76 to 1.16; P=0.48) or in any of the individual components. Similar results were obtained in a per-protocol analysis that excluded the 177 patients who crossed over from the assigned treatment to the other treatment.CONCLUSIONS: In patients 75 years of age or older, there was no significant difference between on-pump and off-pump CABG with regard to the composite outcome of death, stroke, myocardial infarction, repeat revascularization, or new renal-replacement therapy within 30 days and within 12 months after surgery. (Funded by Maquet; GOPCABE ClinicalTrials.gov number, NCT00719667.).
AB - BACKGROUND: The benefits of coronary-artery bypass grafting (CABG) without cardiopulmonary bypass in the elderly are still undetermined.METHODS: We randomly assigned patients 75 years of age or older who were scheduled for elective first-time CABG to undergo the procedure either without cardiopulmonary bypass (off-pump CABG) or with it (on-pump CABG). The primary end point was a composite of death, stroke, myocardial infarction, repeat revascularization, or new renal-replacement therapy at 30 days and at 12 months after surgery.RESULTS: A total of 2539 patients underwent randomization. At 30 days after surgery, there was no significant difference between patients who underwent off-pump surgery and those who underwent on-pump surgery in terms of the composite outcome (7.8% vs. 8.2%; odds ratio, 0.95; 95% confidence interval [CI], 0.71 to 1.28; P=0.74) or four of the components (death, stroke, myocardial infarction, or new renal-replacement therapy). Repeat revascularization occurred more frequently after off-pump CABG than after on-pump CABG (1.3% vs. 0.4%; odds ratio, 2.42; 95% CI, 1.03 to 5.72; P=0.04). At 12 months, there was no significant between-group difference in the composite end point (13.1% vs. 14.0%; hazard ratio, 0.93; 95% CI, 0.76 to 1.16; P=0.48) or in any of the individual components. Similar results were obtained in a per-protocol analysis that excluded the 177 patients who crossed over from the assigned treatment to the other treatment.CONCLUSIONS: In patients 75 years of age or older, there was no significant difference between on-pump and off-pump CABG with regard to the composite outcome of death, stroke, myocardial infarction, repeat revascularization, or new renal-replacement therapy within 30 days and within 12 months after surgery. (Funded by Maquet; GOPCABE ClinicalTrials.gov number, NCT00719667.).
KW - Aged
KW - Aged, 80 and over
KW - Coronary Artery Bypass/methods
KW - Coronary Artery Bypass, Off-Pump
KW - Coronary Artery Disease/mortality
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Intention to Treat Analysis
KW - Kaplan-Meier Estimate
KW - Male
KW - Myocardial Infarction/etiology
KW - Postoperative Complications
KW - Proportional Hazards Models
KW - Quality of Life
KW - Renal Insufficiency/etiology
KW - Reoperation/statistics & numerical data
KW - Stroke/etiology
U2 - 10.1056/NEJMoa1211666
DO - 10.1056/NEJMoa1211666
M3 - SCORING: Journal article
C2 - 23477657
VL - 368
SP - 1189
EP - 1198
JO - NEW ENGL J MED
JF - NEW ENGL J MED
SN - 0028-4793
IS - 13
ER -
