To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: On-Pump Preferred to Off-Pump Revascularisation for Patients With Multivessel Chronic Coronary Artery Disease: Presented at ESC URL: http://www.pslgroup.com/dg/22AC86.htm Doctor's Guide September 4, 2008
By Chris Berrie MUNICH, Germany -- September 4, 2008 -- Patients with multivessel chronic coronary artery disease (CAD) and preserved left-ventricular function have better outcomes in terms of the composite endpoint of cardiac death, myocardial infarction (MI), and refractory angina with on-pump compared with off-pump revascularisation, according to research reported here at the European Society of Cardiology 2008 Congress (ESC). The randomised study was presented here on September 1 by Luiz Machado Cesar, MD, PhD, Chronic Coronary Unit, Heart Institute, University of São Paolo Medical School, São Paolo, Brazil. Increasing concern over the last 10 years regarding the need to reduce mortality and morbidity with on-pump coronary artery bypass graft (CABG) procedures led to development of off-pump procedures. Some studies have shown that the 2 procedures have the same results, at least at 3 to 6 months, Dr. Machado Cesar said. To determine longer-term relative outcomes during surgery and through patient follow-up to 3 years postsurgery, Dr. Machado Cesar and colleagues evaluated primary endpoints of cardiac death, myocardial infarction (MI), and refractory angina requiring a new intervention. The study included patients with multivessel chronic CAD and preserved left-ventricular function who needed a CABG procedure and were suitable for either on-pump or off-pump revascularisation. A total of 144 patients with a mean age of 60.4 years were randomised to on-pump CABG and 142 patients with a mean age of 61.4 years had the off-pump procedure. Men made up 79.6% and 78.4% of each group, respectively. There were no significant differences across these groups for patient medical histories or angiographic findings. Periprocedural data were similar for the 2 groups, except that the on-pump group had a larger number of grafts per patient (3.65 vs 2.75; P < .001), more grafting of the left circumflex artery (82.0% vs 66.3%; P < .001), and longer operating time (6.6 vs 4.9 hours; P < .001). The on-pump group required 61.5 minutes on cardiopulmonary bypass and 48.4 minutes of cross-clamp time; there was a mean of 3 switches to cardiopulmonary bypass with the off-pump procedure. The primary endpoint of cardiovascular mortality at the end of 3 years of follow-up was not significantly different between on-pump and off-pump patient survival rates (99.3% vs 97.9%, respectively). However, the probability for event-free survival of the off-pump full composite endpoint (87.1%) was significantly lower than that of the on-pump group (94.8%; P = .027). For periprocedural and in-hospital complications, the only significant differences were increased blood requirement with on-pump versus off-pump procedures (56.6% vs 40.7%; P < .001) and increased occurrence of atrial fibrillation with off-pump procedures (29.2% vs 4.4%; P < .001). Dr. Machado Cesar noted that this effect might be due to the production of corticoids during the on-pump procedure. Finally, he indicated that while there was no difference in mortality rates at 3 years, "some patients in the off-pump [group] had less vessels revascularised, and thus they were more prone to have a second revascularisation." [Presentation title: MASS-III: A Randomised Study Comparing On-Pump and Off-Pump Coronary Artery Bypass Graft Surgery: 3-Year Results. Abstract P1885] --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content. --------------------------------------------------------------------------------------------- This news story was printed from *Doctor's Guide to the Internet* located at http://www.docguide.com --------------------------------------------------------------------------------------- Return to News Story Page This site is maintained by webmaster@pslgroup.com Please contact us with any comments, problems or bugs. All contents Copyright (c) 1998 P\S\L Consulting Group Inc. All rights reserved.