On-pump versus off-pump surgical revascularization in patients with acute coronary syndromes: Analysis from the Acute Catheterization and Urgent Intervention Triage Strategy trial

Yanai Ben-Gal, Gregg W. Stone, Craig R. Smith, Mathew R. Williams, Giora Weisz, Allan S. Stewart, Hiroo Takayama, Philippe Genereux, Michael Argenziano

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objective: Early invasive strategy, defined as early coronary angiography and subsequent revascularization, when appropriate, is recommended by current guidelines for the management of patients with moderate- to high-risk acute coronary syndromes. We sought to compare the outcomes of patients with acute coronary syndromes undergoing surgical revascularization with an on-pump versus off-pump approach. Methods: Among a total of 13,819 patients with moderate- to high-risk acute coronary syndromes enrolled in the Acute Catheterization and Urgent Intervention Triage Strategy trial, 1375 patients were triaged to isolated coronary artery bypass grafting. One thousand one hundred fifty-four patients underwent operations with cardiopulmonary bypass (the coronary artery bypass grafting group), and 221 patients underwent off-pump coronary artery bypass grafting (the off-pump coronary artery bypass grafting group). Propensity score matching (1:3) was applied to adjust for differences in baseline clinical and angiographic characteristics, yielding a total of 880 matched patients with acute coronary syndromes (220 managed with off-pump coronary artery bypass grafting and 660 managed with coronary artery bypass grafting). Results: At 30 days, patients undergoing off-pump coronary artery bypass grafting had fewer events of bleeding (43.7% vs 56.3%, P = .0005) and myocardial infarction (7.3% vs 12.1%, P = .055) but higher rates of reintervention (3.7% vs 1.2%, P = .02). At 1 year, there was no difference between groups in death, total myocardial infarctions, reinterventions, strokes, or major adverse cardiac events, but there was a lower rate of non-Q-wave myocardial infarctions in the off-pump coronary artery bypass grafting group (4.6% vs 9.2%, P = .03). Conclusions: In this large-scale study evaluating the outcomes of patients with acute coronary syndromes, off-pump coronary artery bypass grafting was associated with lower rates of bleeding and non-Q-wave myocardial infarction but more reinterventions early after the procedure. At 1 year, there was no major outcome difference between the 2 surgical strategies.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
Volume142
Issue number2
DOIs
StatePublished - Aug 1 2011
Externally publishedYes

Fingerprint

Triage
Acute Coronary Syndrome
Coronary Artery Bypass
Catheterization
Off-Pump Coronary Artery Bypass
Myocardial Infarction
Hemorrhage
Propensity Score
Coronary Angiography
Cardiopulmonary Bypass
Stroke
Outcome Assessment (Health Care)
Guidelines

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Ben-Gal, Yanai ; Stone, Gregg W. ; Smith, Craig R. ; Williams, Mathew R. ; Weisz, Giora ; Stewart, Allan S. ; Takayama, Hiroo ; Genereux, Philippe ; Argenziano, Michael. / On-pump versus off-pump surgical revascularization in patients with acute coronary syndromes : Analysis from the Acute Catheterization and Urgent Intervention Triage Strategy trial. In: Journal of Thoracic and Cardiovascular Surgery. 2011 ; Vol. 142, No. 2.
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abstract = "Objective: Early invasive strategy, defined as early coronary angiography and subsequent revascularization, when appropriate, is recommended by current guidelines for the management of patients with moderate- to high-risk acute coronary syndromes. We sought to compare the outcomes of patients with acute coronary syndromes undergoing surgical revascularization with an on-pump versus off-pump approach. Methods: Among a total of 13,819 patients with moderate- to high-risk acute coronary syndromes enrolled in the Acute Catheterization and Urgent Intervention Triage Strategy trial, 1375 patients were triaged to isolated coronary artery bypass grafting. One thousand one hundred fifty-four patients underwent operations with cardiopulmonary bypass (the coronary artery bypass grafting group), and 221 patients underwent off-pump coronary artery bypass grafting (the off-pump coronary artery bypass grafting group). Propensity score matching (1:3) was applied to adjust for differences in baseline clinical and angiographic characteristics, yielding a total of 880 matched patients with acute coronary syndromes (220 managed with off-pump coronary artery bypass grafting and 660 managed with coronary artery bypass grafting). Results: At 30 days, patients undergoing off-pump coronary artery bypass grafting had fewer events of bleeding (43.7{\%} vs 56.3{\%}, P = .0005) and myocardial infarction (7.3{\%} vs 12.1{\%}, P = .055) but higher rates of reintervention (3.7{\%} vs 1.2{\%}, P = .02). At 1 year, there was no difference between groups in death, total myocardial infarctions, reinterventions, strokes, or major adverse cardiac events, but there was a lower rate of non-Q-wave myocardial infarctions in the off-pump coronary artery bypass grafting group (4.6{\%} vs 9.2{\%}, P = .03). Conclusions: In this large-scale study evaluating the outcomes of patients with acute coronary syndromes, off-pump coronary artery bypass grafting was associated with lower rates of bleeding and non-Q-wave myocardial infarction but more reinterventions early after the procedure. At 1 year, there was no major outcome difference between the 2 surgical strategies.",
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On-pump versus off-pump surgical revascularization in patients with acute coronary syndromes : Analysis from the Acute Catheterization and Urgent Intervention Triage Strategy trial. / Ben-Gal, Yanai; Stone, Gregg W.; Smith, Craig R.; Williams, Mathew R.; Weisz, Giora; Stewart, Allan S.; Takayama, Hiroo; Genereux, Philippe; Argenziano, Michael.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 142, No. 2, 01.08.2011.

Research output: Contribution to journalArticle

TY - JOUR

T1 - On-pump versus off-pump surgical revascularization in patients with acute coronary syndromes

T2 - Analysis from the Acute Catheterization and Urgent Intervention Triage Strategy trial

AU - Ben-Gal, Yanai

AU - Stone, Gregg W.

AU - Smith, Craig R.

AU - Williams, Mathew R.

AU - Weisz, Giora

AU - Stewart, Allan S.

AU - Takayama, Hiroo

AU - Genereux, Philippe

AU - Argenziano, Michael

PY - 2011/8/1

Y1 - 2011/8/1

N2 - Objective: Early invasive strategy, defined as early coronary angiography and subsequent revascularization, when appropriate, is recommended by current guidelines for the management of patients with moderate- to high-risk acute coronary syndromes. We sought to compare the outcomes of patients with acute coronary syndromes undergoing surgical revascularization with an on-pump versus off-pump approach. Methods: Among a total of 13,819 patients with moderate- to high-risk acute coronary syndromes enrolled in the Acute Catheterization and Urgent Intervention Triage Strategy trial, 1375 patients were triaged to isolated coronary artery bypass grafting. One thousand one hundred fifty-four patients underwent operations with cardiopulmonary bypass (the coronary artery bypass grafting group), and 221 patients underwent off-pump coronary artery bypass grafting (the off-pump coronary artery bypass grafting group). Propensity score matching (1:3) was applied to adjust for differences in baseline clinical and angiographic characteristics, yielding a total of 880 matched patients with acute coronary syndromes (220 managed with off-pump coronary artery bypass grafting and 660 managed with coronary artery bypass grafting). Results: At 30 days, patients undergoing off-pump coronary artery bypass grafting had fewer events of bleeding (43.7% vs 56.3%, P = .0005) and myocardial infarction (7.3% vs 12.1%, P = .055) but higher rates of reintervention (3.7% vs 1.2%, P = .02). At 1 year, there was no difference between groups in death, total myocardial infarctions, reinterventions, strokes, or major adverse cardiac events, but there was a lower rate of non-Q-wave myocardial infarctions in the off-pump coronary artery bypass grafting group (4.6% vs 9.2%, P = .03). Conclusions: In this large-scale study evaluating the outcomes of patients with acute coronary syndromes, off-pump coronary artery bypass grafting was associated with lower rates of bleeding and non-Q-wave myocardial infarction but more reinterventions early after the procedure. At 1 year, there was no major outcome difference between the 2 surgical strategies.

AB - Objective: Early invasive strategy, defined as early coronary angiography and subsequent revascularization, when appropriate, is recommended by current guidelines for the management of patients with moderate- to high-risk acute coronary syndromes. We sought to compare the outcomes of patients with acute coronary syndromes undergoing surgical revascularization with an on-pump versus off-pump approach. Methods: Among a total of 13,819 patients with moderate- to high-risk acute coronary syndromes enrolled in the Acute Catheterization and Urgent Intervention Triage Strategy trial, 1375 patients were triaged to isolated coronary artery bypass grafting. One thousand one hundred fifty-four patients underwent operations with cardiopulmonary bypass (the coronary artery bypass grafting group), and 221 patients underwent off-pump coronary artery bypass grafting (the off-pump coronary artery bypass grafting group). Propensity score matching (1:3) was applied to adjust for differences in baseline clinical and angiographic characteristics, yielding a total of 880 matched patients with acute coronary syndromes (220 managed with off-pump coronary artery bypass grafting and 660 managed with coronary artery bypass grafting). Results: At 30 days, patients undergoing off-pump coronary artery bypass grafting had fewer events of bleeding (43.7% vs 56.3%, P = .0005) and myocardial infarction (7.3% vs 12.1%, P = .055) but higher rates of reintervention (3.7% vs 1.2%, P = .02). At 1 year, there was no difference between groups in death, total myocardial infarctions, reinterventions, strokes, or major adverse cardiac events, but there was a lower rate of non-Q-wave myocardial infarctions in the off-pump coronary artery bypass grafting group (4.6% vs 9.2%, P = .03). Conclusions: In this large-scale study evaluating the outcomes of patients with acute coronary syndromes, off-pump coronary artery bypass grafting was associated with lower rates of bleeding and non-Q-wave myocardial infarction but more reinterventions early after the procedure. At 1 year, there was no major outcome difference between the 2 surgical strategies.

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