E-Abstract

JACC

Lots of interesting abstracts and cases were submitted for TCTAP 2023. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!

TCTAP A-039

On-Pump and Off-Pump Coronary Artery Bypass Grafting on 10-Year Mortality Versus Percutaneous Coronary Intervention

By Patrick W. Serruys, Shigetaka Kageyama, Kai Ninomiya, Neil O’Leary, Shinichiro Masuda, Nozomi Kotoku, Antonio Colombo, Robert Van Geuns, Michael J. Mack, Scot Garg, Yoshinobu Onuma

Presenter

Patrick W. Serruys

Authors

Patrick W. Serruys1, Shigetaka Kageyama1, Kai Ninomiya1, Neil O’Leary1, Shinichiro Masuda1, Nozomi Kotoku1, Antonio Colombo2, Robert Van Geuns3, Michael J. Mack4, Scot Garg5, Yoshinobu Onuma1

Affiliation

University of Galway, Ireland1, EMO GVM Centro Cuore Columbus, Italy2, Erasmus MC, Netherlands3, Baylor University Medical Center, USA4, Royal Blackburn Hospital, United Kingdom5
View Study Report
TCTAP A-039
Cardiac Surgery/Hybrid Revascularization

On-Pump and Off-Pump Coronary Artery Bypass Grafting on 10-Year Mortality Versus Percutaneous Coronary Intervention

Patrick W. Serruys1, Shigetaka Kageyama1, Kai Ninomiya1, Neil O’Leary1, Shinichiro Masuda1, Nozomi Kotoku1, Antonio Colombo2, Robert Van Geuns3, Michael J. Mack4, Scot Garg5, Yoshinobu Onuma1

University of Galway, Ireland1, EMO GVM Centro Cuore Columbus, Italy2, Erasmus MC, Netherlands3, Baylor University Medical Center, USA4, Royal Blackburn Hospital, United Kingdom5

Background

The very long-term mortality of off-pump and on-pump coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in a randomized complex coronary artery disease (CAD)population is unknown. This study aims to investigate the impact of on-pump and off-pump CABG versus PCI on 10-year all-cause mortality.

Methods

The SYNTAXES trial randomized 1800 patients with three-vessel and/or left main CAD to PCI or CABG and assessed their survival at10 years. In this sub-study, the hazard of mortality over 10 years was compared according to the technique of revascularization: on-pump CABG (n=725), off-pump CABG (n=128), and PCI (n=903). 

Results

There was substantial inter-site variation in the use of off-pump CABG despite baseline characteristics being largely homogeneous amongst the three groups. The crude rate of mortality was significantly lower following on-pump CABG versus PCI (25.6% vs 28.4%, Hazard Ratio [HR] 0.79, 95%Confidence Interval [CI] 0.65-0.96), whilst it was comparable between off-pump CABG and PCI (28.5% vs 28.4%, HR 0.98, 95%CI 0.69-1.40). After adjusting for the nine variables included in the SYNTAX score II 2020, 10-year mortality remained significantly lower with on-pump CABG than PCI (HR 0.75 against PCI,p=0.009).

Conclusion

In the SYNTAXES trial, 10-year mortality adjusted for major confounders was significantly lower following on-pump CABG compared to PCI, whilst off-pump CABG offered no prognostic survival benefit over PCI. Siteheterogeneity in the technique used in bypass surgery has had measurable effects on treatment performance. Given its impact on outcomes, it should be-stratified in future studies.

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