Long-Term Clinical and Angiographic Outcomes of Off-Pump Versus On-Pump Coronary Artery Bypass Grafting

Introduction: This study aimed to compare long-term outcomes in patients undergoing off-pump coronary artery bypass grafting (OPCAB) versus on-pump coronary artery bypass grafting (ONCAB) in a single-center propensity-matched population. Methods: Between January 2010 and June 2022, 2964 patients were analyzed and divided into two groups: 1671 (56.3%) patients receiving OPCAB and 1293 (43.7%) patients receiving ONCAB. Propensity score matching was performed resulting in 842 pairs. Results: In the matched cohort, OPCAB was associated with a reduced incidence of early stroke (odds ratio: 0.40; 95% confidence interval [0.17-0.90], P = 0.02) as well as a reduced incidence of reoperation for bleeding and blood transfusion. The median follow-up time was 6.69 y (interquartile range: 3.47-9.83-y). OPCAB and ONCAB had comparable long-term mortality, myocardial infarction, repeat revascularization, and major adverse cardiac and cerebral events. However, OPCAB was associated with higher freedom from stroke at follow-up compared to ONCAB (hazard ratios stratified on matched pairs: 0.61; 95% confidence interval [0.39-0.95]; P = 0.015). A landmark analysis in the matched cohort was performed excluding the first 30 ds of follow-up to exclude the effect of early stroke. In the landmark analysis, OPCAB and ONCAB had comparable freedom from stroke at follow-up. Briefly, 821 patients with 2055 grafts were analyzed. The overall median time to angiogram was 3.68 y (interquartile range: 1.76-6.61). No difference was observed between OPCAB and ONCAB in the patency rates (Fitzgibbon A) of arterial grafts. However, the patency rate of saphenous vein graft was higher in the OPCAB group than in the ONCAB group (77.4% versus 71.7%, P = 0.04). Conclusions: OPCAB was associated with lower rates of stroke, reoperation for bleeding, and blood product transfusion. Meanwhile, at long-term follow-up, OPCAB and ONCAB were associated with comparable outcomes, including all-cause mortality, myocardial infarction, repeat revascularization, major adverse cardiac and cerebral events, and stroke.