European Heart Journal Advance Access originally published online on September 15, 2006
European Heart Journal 2006 27(20):2473-2480; doi:10.1093/eurheartj/ehl256
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Outcomes in off-pump vs. on-pump coronary artery bypass grafting stratified by pre-operative risk profile: an assessment using propensity score
1 Epidemiology Unit, Department of Cardiology, Vall d'Hebron Hospital, Paseo Vall d'Hebron 119-129, Barcelona 08035, Spain
2 Department of Internal Medicine, Universitat Autónoma, Barcelona, Spain
3 Department of Health and Experimental Sciences, Universitat Pompeu Fabra, Barcelona, Spain
Received 21 March 2006; revised 21 August 2006; accepted 31 August 2006; online publish-ahead-of-print 15 September 2006.
* Corresponding author. Tel: +34 932746177; fax: +34 933746063. E-mail address: gpermany{at}vhebron.net
Aims To assess the benefit of off-pump coronary surgery stratified by the pre-operative risk profile.
Methods and results Prospective and multicentric cohort study. All consecutive patients undergoing a first coronary bypass procedure between November 2001 and November 2003 were potentially eligible. Pre-operative EuroSCORE and in-hospital outcomes were prospectively collected using strictly standardized criteria. To ensure optimal adjustment, a propensity score was constructed using clinically relevant variables and incorporating individual centres. Of 1602 patients who underwent a first coronary bypass, EuroSCORE could be calculated in 1585: 787 were of moderate/high pre-operative risk profile (EuroSCORE>3), of which 347 underwent off-pump procedures, and 798 were of low pre-operative risk profile (EuroSCORE
3), of which 349 underwent off-pump procedures. After risk adjusting for propensity score, off-pump patients had less major events (post-operative death, myocardial infarction, and need for reoperation). This benefit was higher in the low-risk stratum (OR ranged between 0.27 and 0.4; P=0.02–0.07) than in the high-risk stratum (OR between 0.4 and 0.7; P, not significant).
Conclusion In real-life conditions, off-pump coronary surgery may be more effective than on-pump surgery. In contrast with previous reports, our results suggest that this benefit may be higher in patients with low pre-operative risk.
Key Words: Coronary disease • Revascularization • Extracorporeal circulation • Surgery
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