Early and long-term outcomes in the elderly: comparison between off-pump and on-pump techniques in 1191 patients undergoing coronary artery bypass grafting.

Abstract

The aim of the present study was to investigate the influence of off-pump coronary artery bypass grafting on early and long-term mortality and morbidity in a consecutive series of elderly patients (aged > 65 years) compared with conventional coronary artery bypass grafting. From January of 1999 to December of 2003, data were extracted for 1191 patients aged more than 65 years: a conventional coronary artery bypass grafting group (n = 744) and an off-pump coronary artery bypass grafting group (n = 447). Age-related early outcomes of interest were in-hospital mortality and postoperative morbidities. Long-term outcomes, including total mortality, repeated revascularization, Q-wave myocardial infarction, stroke, readmission, and the combination of death, Q-wave myocardial infarction, stroke, and repeated revascularization, were evaluated with Cox regression analysis. Univariate analysis for early outcomes showed significant benefits from off-pump coronary artery bypass grafting. After adjustment for baseline characteristics, there was still a benefit of off-pump coronary artery bypass grafting. Kaplan-Meier survival analyses (propensity matched cases) showed that stroke, major adverse cardiac and cerebrovascular events, and readmission occurred more frequently in the off-pump coronary artery bypass grafting group (P < .001). There was a nonsignificant trend to higher total mortality (P = .193) and higher repeated revascularization rates (P = .067) in the off-pump coronary artery bypass grafting group. Cox regression for long-term outcomes showed that patients in the off-pump coronary artery bypass grafting group had a higher incidence of stroke (hazard ratio 2.611, 95% confidence interval 2.152-3.070), readmission (hazard ratio 2.000, 95% confidence interval 1.747-2.253), and major adverse cardiac and cerebrovascular events (hazard ratio 1.764, 95% confidence interval 1.456-2.072). Our analysis shows that off-pump coronary artery bypass grafting compared with conventional coronary artery bypass grafting was associated with favorable early outcomes in the elderly population. However, the early benefits of off-pump coronary artery bypass grafting were not maintained in the long term, and off-pump coronary artery bypass grafting showed trends toward worse long-term results.