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a Joseph B. Whitehead Department of Surgery, Division of Cardiothoracic Surgery, Carlyle Fraser Heart Center, Cardiothoracic Surgery Clinical Research Unit, University School of Medicine, Atlanta, Georgia
b Department of Biostatistics, Rollins School of Public Health, Emory, University School of Medicine, Atlanta, Georgia
Accepted for publication June 5, 2007.
* Address correspondence to Dr Lattouf, Emory University School of Medicine, Emory Crawford Long Hospital, 6th Floor, Medical Office Tower, 550 Peachtree St NE, Atlanta, GA 30308. (Email: omar.lattouf{at}emoryhealthcare.org).
Presented at the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007.
Background: It is not known whether surgeons preferentially assign patients requiring fewer grafts (1 to 3) to off-pump coronary artery bypass graft surgery (OPCABG) and those requiring many grafts (4 to 7) to conventional on-pump coronary artery bypass graft surgery (ONCABG), nor whether risk-adjusted outcomes are similar for OPCABG and ONCABG among patients receiving 1 to 3 and 4 to 7 grafts.
Methods: Emory Hospitals’ prospective database was retrospectively reviewed for 11,413 consecutive, isolated, primary coronary revascularization procedures between January 1997 and May 2005. Patients were divided into four groups: OPCABG 1 to 3 grafts (n = 3,187), OPCABG 4 to 7 grafts (n = 1,305), ONCABG 1 to 3 grafts (n = 3,279), and ONCABG 4 to 7 grafts (n = 3,642). A propensity score for surgery type was estimated from 39 risk factors. Multivariable logistic regression examined independent impact of surgery type and number of vessels grafted on outcomes. Computed interactions determined whether the effect of surgery type on risk-adjusted outcomes was consistent across groups.
Results: Patients requiring 4 to 7 grafts had adjusted odds of receiving ONCABG 2.92 times higher than patients requiring 1 to 3 grafts (p < 0.001). The OPCABG patients had adjusted odds ratios of 0.53 for death (p = 0.007), 0.42 for stroke (p < 0.001), 0.51 for major adverse cardiac events (p < 0.001), and 0.71 for renal failure (p = 0.05) as compared with ONCABG patients. The interaction between OPCABG and number of vessels grafted was not statistically significant.
Conclusions: This study demonstrates that surgeons tend to perform OPCABG for patients requiring 1 to 3 grafts and ONCABG for those requiring 4 to 7 grafts. Off-pump CABG is associated with reduced adjusted risk of adverse outcomes compared with ONCABG. This benefit is consistent for patients requiring 1 to 3 or 4 to 7 grafts.
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