Long-term survival after off-pump coronary artery bypass surgery: a Swedish nationwide cohort study.

BACKGROUND

The aim of this study was to analyze long-term survival after primary isolated off-pump coronary artery bypass grafting (CABG) compared with on-pump CABG in a nationwide patient cohort.

METHODS

Patients who underwent primary isolated nonemergent CABG in Sweden between 1998 and 2008 were identified. Swedish registers were used to gather patient data and outcomes. Multivariable regression models were used to estimate the association between off-pump CABG and early mortality, long-term survival, and a composite of death from any cause or rehospitalization for myocardial infarction, heart failure, or stroke. Similar analyses were repeated in a propensity score-matched cohort.

RESULTS

The study included 50,676 patients, and 3,337 (6.6%) underwent off-pump CABG. In the adjusted analyses, off-pump CABG was not associated with better survival compared with on-pump CABG in the overall cohort (hazard ratio [HR] for death: 0.99, 95% confidence interval [CI]): 0.92 to 1.06) or in the matched cohort (HR: 1.02, 95% CI: 0.91 to 1.16). The results were similar for early mortality (odds ratio: 1.25, 95% CI: 0.95 to 1.65), and the composite endpoint (HR: 0.99, 95% CI: 0.94 to 1.05).

CONCLUSIONS

Long-term survival was similar between off-pump and on-pump CABG in patients undergoing non-emergent primary isolated CABG in Sweden from 1998 to 2008. Off-pump CABG was performed infrequently and there was a continuous decline in the number of procedures during the study period.