Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara, Sakyo, Kyoto 606-8507 Japan.
Circulation. 2012 Sep 11;126(11 Suppl 1):S151-7. doi: 10.1161/CIRCULATIONAHA.111.083873.
The benefits of off-pump coronary artery bypass graft (OPCAB) compared with conventional on-pump coronary artery bypass graft (CCAB) remain controversial. Thus, it is important to investigate which patient subgroups may benefit the most from OPCAB rather than CCAB.
Among the patients undergoing first coronary revascularization enrolled in the CREDO-Kyoto Registry (a registry of first-time percutaneous coronary intervention and coronary artery bypass graft patients in Japan), 2468 patients undergoing coronary artery bypass graft were entered into the study (mean age, 67 ± 9 years). Predicted risk of operative mortality (PROM) of each patient was calculated by logistic EuroSCORE. Patients were divided into tertile based on their PROM. Mortality rates and the incidences of cardiovascular events were compared between CCAB and OPCAB within each PROM tertile using propensity score analysis. A total of 1377 patients received CCAB whereas 1091 received OPCAB. Adjusted 30-day mortality was not significantly different between CCAB and OPCAB patients regardless of their PROM range. However, the odds ratio of 30-day stroke in CCAB compared with OPCAB in the high-risk tertile was 8.30 (95% confidence interval, 2.25-30.7; P<0.01). Regarding long-term outcomes, hazard ratio of stroke in CCAB compared with OPCAB in the high-risk tertile was 1.80 (95% confidence interval, 1.07-3.02; P=0.03). Nevertheless, hazard ratio of overall mortality in the high-risk tertile was 1.44 (95% confidence interval, 0.98-2.11; P=0.06), indicating no statistically significant difference between the 2 procedures.
OPCAB as opposed to CCAB is associated with short-term and long-term benefits in stroke prevention in patients at higher risk as estimated by EuroSCORE. No survival benefit of OPCAB was shown regardless of preoperative risk level.
非体外循环冠状动脉旁路移植术（OPCAB）与传统体外循环冠状动脉旁路移植术（CCAB）相比的优势仍存在争议。因此，重要的是要研究哪些患者亚组可能从 OPCAB 而非 CCAB 中获益最大。
在日本首次经皮冠状动脉介入治疗和冠状动脉旁路移植术患者登记的 CREDO-Kyoto 登记研究（一项首次经皮冠状动脉介入治疗和冠状动脉旁路移植术患者的登记研究）中，2468 例接受冠状动脉旁路移植术的患者被纳入研究（平均年龄，67±9 岁）。通过 logistic EuroSCORE 计算每位患者的手术死亡率预测风险（PROM）。根据 PROM 将患者分为三分位。使用倾向评分分析比较每个 PROM 三分位内 CCAB 和 OPCAB 之间的死亡率和心血管事件发生率。共有 1377 例患者接受 CCAB，1091 例患者接受 OPCAB。无论 PROM 范围如何，CCAB 和 OPCAB 患者的 30 天死亡率均无显著差异。然而，在高危三分位中，CCAB 与 OPCAB 相比，30 天卒中的优势比为 8.30（95%置信区间，2.25-30.7；P<0.01）。关于长期结果，在高危三分位中，CCAB 与 OPCAB 相比，卒中的风险比为 1.80（95%置信区间，1.07-3.02；P=0.03）。然而，高危三分位中 CCAB 与 OPCAB 相比，总死亡率的风险比为 1.44（95%置信区间，0.98-2.11；P=0.06），表明这两种手术之间无统计学显著差异。
根据 EuroSCORE 估计，OPCAB 与 CCAB 相比，在风险较高的患者中具有预防卒中的短期和长期优势。无论术前风险水平如何，OPCAB 均未显示出生存获益。
