Joel M. Gore, MD reviewing Lamy A et al. N Engl J Med 2016 Oct 23.
Data on outcomes, cost, and quality of life did not differ significantly between the two coronary artery bypass grafting strategies.

In the multinational, randomized CORONARY trial, comparing off-pump (beating heart) with on-pump coronary artery bypass grafting (CABG), the primary endpoint did not differ significantly between the two groups at 30 days or at 1 year (NEJM JW Cardiol Apr 2013 and N Engl J Med 2013; 368:1179). Researchers now report longer-term follow-up data for the 4752 trial participants.

At a mean follow-up of 4.8 years, the two groups did not differ significantly in the composite endpoint of death, stroke, myocardial infarction, renal failure, or repeat coronary revascularization (off-pump, 23.1%; on-pump, 23.6%), in any of the individual endpoint components, or in mean cost per patient. The primary outcome was also similar between the two groups specifically for the period between 1 year and 4.8 years of follow-up. No prespecified subgroups fared significantly better with one type of CABG versus the other. Quality-of-life measures, assessed in 60% of trial participants, did not differ significantly between the off-pump and on-pump groups.

CITATION(S):

Lamy A et al. Five-year outcomes after off-pump or on-pump coronary-artery bypass grafting. N Engl J Med 2016 Oct 23; [e-pub].

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