Complexity of Coronary Artery Disease and Revascularization Quality in Off-Pump Versus On-Pump Surgery - Analysis from the GOPCABE Study
Konstantin Preindl1, Nobuyuki Furukawa1, Diana Diaz1, Kavous Hakim-Meibodi1, Stephan Ensminger1, Armin Zittermann1, Arno Diegeler2, Jan-Fritz Gummert1, Jochen Börgermann1.
1Herz- und Diabeteszentrum NRW Ruhr University of Bochum, Bad Oeynhausen, Germany, 2Cardiovascular Clinic Bad Neustadt, Bad Neustadt a.d. Saale, Germany.
OBJECTIVE: Revascularization quality in off-pump vs. on-pump coronary surgery is an ongoing and hotly debated issue. This is due to the fact that some randomized studies have shown higher re-revascularization rates, a lower number of peripheral anastomoses and more incomplete revascularizations in off-pump groups. In this single-center analysis from the German Off-Pump Coronary Artery Bypass in the Elderly (GOPCABE) study, revascularization quality is investigated in connection with the complexity of the CAD.
METHODS: 323 patients aged 75 years or above who underwent isolated CABG at our center were randomized. The complexity of the CAD was quantified in the off-pump and on-pump groups using the SYNTAX Score. The primary endpoints of the study were completeness of revascularization (number of grafts, index of completeness of revascularisation (ICOR)), re-revascularization rates in the 4-year follow-up and re-angiography findings, the last being systematically analyzed according to the FitzGibbon and Thrombolysis in Myocardial Infarction Scoring (TIMI) systems.
RESULTS: After 4 years there was no difference between the groups regarding survival or MACCE (death, myocardial infarction, stroke). The complexity of the CAD according to the number of lesions and SYNTAX Score was comparable in the off-pump and on-pump groups (4.21±1.51 vs. 5.05±7.96, p=0.330; 20.4±7.42 vs. 21.3±7.84, p=0.452, respectively). Here the number of peripheral anastomoses performed (2.71±0.68 vs. 2.68±0.74, p=0.570), ICOR (number of grafts performed/number of grafts intended, 0.89±0.23 vs. 0.90±0.22, p=0.723) and the re-revascularization rate (6.8% vs. 8.0, p=0.734) in the 4-year follow-up were not significantly differently. 29 (8,97%) of the patients underwent re-angiography. In the off-pump group 1 stenosed and 28 occluded grafts were found, compared to 5 stenosed and 18 occluded grafts in the on-pump group (see Table).
CONCLUSIONS: In this single-center analysis from the GOPCABE study, there were no significant differences between off-pump and on-pump surgery regarding complexity of the coronary artery disease and revascularization quality.
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