Author + information
- Umberto Benedetto1,
- A. Pieter Kappetein2,
- William Brown3,
- Piet Willem Boonstra4,
- Nicolas Noiseux5,
- Ovidiu Dressler6,
- Gregg Stone7,
- Patrick Serruys8 and
- Joseph Sabik9
- 1Bristol Heart Institute, University of Bristol School of Clinical Sciences, Bristol, United Kingdom
- 2Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- 3Piedmont Heart Institute CardioThoracic Surgeons, Atlanta, Georgia, United States
- 4Medisch Centrum Leeuwarden, Heart Center, Leeuwarden PObox 888, Netherlands
- 5Montreal Heart Institute, Montreal, Quebec, Canada
- 6Cardiovascular Research Foundation, New York, New York, United States
- 7Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
- 8Imperial College, London, United Kingdom
- 9Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, United States
Whether off-pump CABG in patients with left main stem (LMS) disease is as safe and effective as on-pump surgery remains to be determined.
The EXCEL trial compared PCI with everolimus-eluting stents vs CABG in 1905 patients undergoing left main revascularization. A total of 271 (29%) patients assigned to CABG were treated with off-pump surgery, while 652 (71%) were treated with on-pump surgery. We conducted a post-hoc analysis of the EXCEL trial to compare 3-year clinical outcomes between off-pump and on-pump surgery including death, myocardial infarction (MI), cerebrovascular accident (CVA) and unplanned revascularization. Due to lack of randomization between the two groups, stepwise multivariate Cox regression was used to adjust for the effects of off-pump vs on-pump surgery.
At 3 years, crude mortality rates in the off-pump and on-pump group were 8.7% (22) vs 4.8% (30), respectively (P=0.04). No significant differences between off-pump and on-pump groups were present for the unadjusted rates of MI (5.4%  vs 8.4% , P=0.11), CVA (5.3%  vs 3.8% , P=0.36) or unplanned revascularization (8.6%  vs 7.3% , P=0.46). After adjusting for confounding factors, the risk of death was not significantly higher with off-pump surgery (HR 1.68; 95%CI 0.91-3.12; P=0.10); nor was composite of death, MI, or CVA significantly different (HR 0.95; 95%CI 0.65-1.40, P=0.79; Figure).
In the EXCEL trial, off-pump and on-pump CABG were equally safe and effective at 3 years in patients with LMS disease.
CORONARY: Cardiac Surgery