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Impact of on-pump and off-pump coronary artery bypass grafting on 10-year mortality versus percutaneous coronary intervention

2023; Oxford University Press; Volume: 64; Issue: 2 Linguagem: Inglês

10.1093/ejcts/ezad240

1873-734X

Shigetaka Kageyama, Patrick W. Serruys, Kai Ninomiya, Neil O’Leary, Shinichiro Masuda, Nozomi Kotoku, Antonio Colombo, Robert‐Jan van Geuns, Milan Milojevic, Michael J. Mack, Alan Soo, Scot Garg, Yoshinobu Onuma, Piroze Davierwala, Filip Casselman, Bernard De Bruyne, Evald Høj Christiansen, Juan M. Ruiz-Nodar, Paul Vermeersch, Werner Schultz, Manel Sabaté, Giulio Guagliumi, Herko Grubitzsch, Karl Stangl, Olivier Darremont, Mohammed Bentala, Peter den Heijer, István Préda, Robert Stoler, Michael J. Mack, Tamás Szerafin, John K. Buckner, Myles S. Guber, Niels Verberkmoes, Ferdi Akca, Ted Feldman, Friedhelm Beyersdorf, Benny Drieghe, Keith G. Oldroyd, Geoff Berg, Anders Jeppsson, Kimberly Barber, Kevin Wolschleger, John Heiser, Pim van der Harst, Massimo A. Mariani, Hermann Reichenspurner, Christoffer Stark, Mika Laine, Paul C. Ho, John C. Chen, Richard Zelman, Phillip A. Horwitz, Andrzej Bochenek, Agata Krauze, Christina Grothusen, Dariusz Dudek, George P. Heyrich, Piroze Davierwala, Thilo Noack, Philippe Kolh, Victor Legrand, Pedro Coelho, Stephan Ensminger, Boris Nasseri, Richard Ingemansson, Göran Olivecrona, Javier Escaned, Reddy Guera, Sérgio Berti, Marie‐Claude Morice, Alaide Chieffo, M. Nicholas Burke, Michael Mooney, Alvise Spolaor, Christian Hagl, Michael Näbauer, Maarten J. Suttorp, Ronald A. Stine, Thomas McGarry, Scott Lucas, Knut Endresen, Andrew Taussig, Kevin Accola, Umberto Canosi, Iván Horváth, Louis Cannon, John D. Talbott, C W Akins, Robert S. Kramer, Michael Aschermann, William A. Killinger, Inga Narbute, David R. Holmes, Francesco Burzotta, Ad J.J.C. Bogers, Felix Zijlstra, Hélène Eltchaninoff, Jacques Berland, Giulio Stefanini, Ignacio Cruz‐González, Uta C. Hoppe, Stefan Kiesz, Bartłomiej Góra, Anders Ahlsson, Matthias Corbascio, Thomas V. Bilfinger, Didier Carrié, Didier Tchetché, Karl-Eugen Hauptman, Elisabeth Ståhle, Stefan James, Sigrid Sandner, Günther Laufer, Iréne Lang, Adam Witkowski, Vinod H. Thourani, Harry Suryapranata, Simon Redwood, Charles Knight, Philip MacCarthy, Nick Curzen, Adam de Belder, Adrian Banning, Anthony Gershlick,

Coronary Interventions and Diagnostics

The very long-term mortality of off-pump and on-pump coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in a randomized complex coronary artery disease population is unknown. This study aims to investigate the impact of on-pump and off-pump CABG versus PCI on 10-year all-cause mortality.The SYNTAX trial randomized 1800 patients with three-vessel and/or left main coronary artery disease to PCI or CABG and assessed their survival at 10 years. In this sub-study, the hazard of mortality over 10 years was compared according to the technique of revascularization: on-pump CABG (n = 725), off-pump CABG (n = 128) and PCI (n = 903).There was substantial inter-site variation in the use of off-pump CABG despite baseline characteristics being largely homogeneous among the 3 groups. The crude rate of mortality was significantly lower following on-pump CABG versus PCI [25.6% vs 28.4%, hazard ratio (HR) 0.79, 95% confidence interval (CI) 0.65-0.96], while it was comparable between off-pump CABG and PCI (28.5% vs 28.4%, HR 0.98, 95% CI 0.69-1.40). After adjusting for the 9 variables included in the SYNTAX score II 2020, 10-year mortality remained significantly lower with on-pump CABG than PCI (HR 0.75 against PCI, P = 0.009).In the SYNTAXES trial, 10-year mortality adjusted for major confounders was significantly lower following on-pump CABG compared to PCI. There was no evidence for unadjusted difference between off-pump CABG and PCI, although the unadjusted estimated HR had a wide CI. Site heterogeneity in the technique used in bypass surgery has had measurable effects on treatment performance.