Outcomes of off-pump versus on-pump coronary artery bypass surgery in end-stage renal disease patients with a history of myocardial infarction.

BACKGROUND

Patients with end-stage renal disease (ESRD) and myocardial infarction (MI) have poor survival. Coronary artery bypass grafting (CABG) in select patients is an effective treatment strategy; however, whether operative technique influences hospital outcome is not defined.

METHODS

Between 1995 and 2000, 342 patients had ESRD (creatinine >2.0 mg/dL or dialysis) and a history of MI at the time of CABG. There were 67 patients that had off-pump coronary artery bypass (OPCAB) (OFF) and 275 that had CABG (ON). The OFF group was compared to the ON group for clinical, operative, outcome data, and influence of acuity of MI.

RESULTS

The OFF group was older (P = .09), but hypertension was more common in the ON group (82% versus 69%, P = .02). The frequency of diabetes, congestive heart failure, peripheral vascular disease, and dyslipidemia were common, but not different between groups. For the OFF versus ON group, creatinine serum level was 3.6 +/- 2.6 versus 3.5 +/- 3.1 (P = 0.17), and history of an acute MI was 39% versus 33% (P = 0.78). The OFF versus ON group had fewer total grafts (2.5 +/- 1 versus 3.8 +/- 1, P < .001). The OFF group had fewer strokes (P = .08), shorter intensive care unit stay (2.4 versus 3.8 days), and shorter hospitalization (8.4 versus 11.7 days), yet mortality was similar (7% versus 9%, P = .79). After acute MI, OFF patients had significantly more postoperative supraventricular tachycardia than ON (69% versus 19%, P < .001).

CONCLUSIONS

Patients with ESRD and an MI have acceptable hospital outcomes regardless of operative strategy. OPCAB or CABG may provide an advantage in certain patients, yet it is the presence of an acute MI that is a predictor of postoperative events.