Vol.3 - No.3

On-pump versus off-pump surgical revascularization in patients with acute coronarysyndromes: Analysis from the Acute Catheterization and Urgent Intervention TriageStrategy trial

By : baghaei

Keywords : -

Objectives

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 fiftyfour
patients underwent operations with cardiopulmonary
bypass (the coronary artery bypass grafting group), and 221patients 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, butthere 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).

Conclusion

In this large-scale study evaluating the outcomes
of patients with acute coronary syndromes, off-pumpcoronary 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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