European Heart Journal Advance Access published online on September 15, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl256
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1 Epidemiology Unit, Department of Cardiology, Vall d'Hebron Hospital, Paseo Vall d'Hebron 119-129, Barcelona 08035, Spain; Department of Internal Medicine, Universitat Autónoma, Barcelona, Spain
* To whom correspondence should be addressed. 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 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.
Received March 21, 2006
Revised August 21, 2006
Accepted August 31, 2006
Clinical research
Outcomes in off-pump vs. on-pump coronary artery bypass grafting stratified by pre-operative risk profile: an assessment using propensity score
Ignacio J. Ferreira-González 1, Aida Ribera 2, Purificación Cascant 3, and Gaietá Permanyer-Miralda 3 *, for the ARCA study group
2 Epidemiology Unit, Department of Cardiology, Vall d'Hebron Hospital, Paseo Vall d'Hebron 119-129, Barcelona 08035, Spain; Department of Health and Experimental Sciences, Universitat Pompeu Fabra, Barcelona, Spain
3 Epidemiology Unit, Department of Cardiology, Vall d'Hebron Hospital, Paseo Vall d'Hebron 119-129, Barcelona 08035, Spain
Gaietá Permanyer-Miralda, E-mail: gpermany{at}vhebron.net
Abstract 
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).
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