Thorac Cardiovasc Surg 2018; 66(06): 470-476
DOI: 10.1055/s-0038-1651516
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Current Status of Off-pump Coronary Artery Bypass Grafting in Patients with Multiple Coronary Artery Disease Compared with On-pump Coronary Artery Bypass Grafting: The Korean National Cohort Study

Hee Jung Kim
1  Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Republic of Korea
,
Jae Eun Chung
2  Clinical Research Center, Korea University Anam Hospital, Korea University, Seoul, Republic of Korea
,
Jae Seung Jung
3  Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
,
In Seup Kim
4  Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea
,
Ho Sung Son
3  Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
› Author Affiliations
Further Information

Publication History

20 February 2018

08 April 2017

Publication Date:
31 May 2018 (online)

Abstract

Background Despite advance in off-pump coronary artery bypass (OPCAB) grafting, there are large debating issues regarding survival benefit between OPCAB and on-pump coronary artery bypass grafting (CABG). The aim of this study is to address appropriateness of OPCAB approach in patients with ischemic heart disease having multiple vessels using South Korea national cohort data.

Methods To evaluate the safety and efficacy of OPCAB, we accessed all causes of death, late repeat revascularization, hospitalization for cerebrovascular accident (CVA), and new renal replacement therapy in patients who underwent isolated CABG with multiple grafting (≥2 grafts) and who were registered in the Korean Health Insurance Review and Assessment Service Database between April 2011 and September 2014.

Results OPCAB was performed in 4,692 patients and on-pump CABG in 2,999 patients from 82 hospitals in South Korea. On multivariable analysis, on–pump CABG was associated with a significantly higher adjusted risk of overall all-cause death (hazard ratio [HR]: 1.876, 95% confidence interval [CI]: 1.587–2.216, p < 0.001) and initiation of new renal replacement therapy (HR: 1.618, 95% CI: 1.124–2.331, p = 0.009). However, we observed no significant difference in repeat revascularization and hospitalization for CVA between the two groups. In propensity score matching, matched patients (2,940 pairs) showed results similar to multivariable analysis that on-pump CABG was associated with a higher overall mortality and initiation of new renal replacement therapy (p < 0.001).

Conclusion In this study, we found that OPCAB was associated with better survival rates and renal preservation compared with on-pump CABG.

Authors' Contributions

Conception and design: H.J. Kim and H.S. Son; administrative support: none; provision of study materials or patients: H.J. Kim; collection and assembly of data: J.E. Chung; data analysis and interpretation: H.J. Kim and J.E. Chung; article writing and final approval of article: all authors.