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Real-World Outcomes of On- vs Off-Pump Coronary Bypass Surgery: Result from Korean Nationwide Cohort

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Abstract
-----------e-pub(22.1.12 현재)----------

Background: While several randomized trials have shown conflicting results regarding the comparative effectiveness of on- and off-pump coronary arterial bypass grafting (CABG), research on long-term outcomes in large-scale, real-world clinical settings are limited. We sought to examine the comparative effectiveness of on- and off-pump CABG in a real-world clinical setting.

Methods: Using the nationwide claims database of the Korean National Health Insurance Service, we identified patients who underwent isolated CABG from 2004 to 2013. Propensity-score matching with multivariable adjustment was used to assemble a cohort of patients with similar baseline characteristics.

Results: Among 23,828 patients, 12,639 in the off-pump (53.0%) and 11,189 in the on-pump (47.0%) groups were enrolled. After matching, 6,483 pairs were included in the final analysis. At 30 days, there was no significant difference in adjusted mortality between the off- and on-pump groups (hazard ratio [HR], 1.00; 95% confidence interval [CI], 0.87-1.16). During long-term follow-up (100% complete; median 5.3yrs, maximum 13.2yrs), however, off-pump CABG was associated with a higher risk of mortality than on-pump CABG (HR, 1.09; 95% CI, 1.03-1.15). The risks of myocardial infarction (MI) (HR, 1.3; 95% CI, 1.16-1.45) and repeat revascularization (HR, 1.50; 95% CI, 1.37-1.63) were also significantly higher in the off-pump CABG group than in the on-pump CABG group, while the stroke risk was similar inter-groups (HR, 0.99; 95% CI, 0.87-1.13).

Conclusions: In this contemporary, nationwide, clinical practice claim registry, off-pump CABG was associated with higher long-term risks of mortality, MI, and repeat revascularization than on-pump CABG.

Keywords: Cardiopulmonary bypass; Comparative effectiveness; Coronary artery bypass graft surgery; Prognosis; Survival.
Author(s)
박성준조애정김효정조송희고민정윤성철박덕우김준범
Issued Date
2021
Type
Article
Keyword
Abridged Index Medicus
DOI
10.1016/j.athoracsur.2021.07.035
URI
https://oak.ulsan.ac.kr/handle/2021.oak/8781
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2562237358&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Real-World%20Outcomes%20of%20On-%20vs%20Off-Pump%20Coronary%20Bypass%20Surgery:%20Result%20from%20Korean%20Nationwide%20Cohort&offset=0&pcAvailability=true
Publisher
ANNALS OF THORACIC SURGERY
Location
미국
Language
영어
ISSN
0003-4975
Citation Volume
0003
Citation Number
4975
Citation Start Page
0
Citation End Page
0
Appears in Collections:
Medicine > Medicine
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