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Puskas JD, Williams WH, Mahoney EM, et al. Off-Pump vs Conventional Coronary Artery Bypass Grafting: Early and 1-Year Graft Patency, Cost, and Quality-of-Life Outcomes: A Randomized Trial. JAMA. 2004;291(15):1841–1849. doi:https://doi.org/10.1001/jama.291.15.1841
Author Affiliations: Divisions of Cardiothoracic Surgery (Drs Puskas, Williams, and Guyton and Mss McCall, Petersen, and Bailey), Cardiology (Drs Huber, Block, Marshall, and Leimbach), and Cardiac Anesthesiology (Drs Duke, Staples, and Glas), Emory University School of Medicine and Emory Center for Outcomes Research (Drs Williams and Weintraub), Atlanta, Ga; and the New England Research Institutes, Watertown, Mass (Dr Mahoney).
Context Previous trials of off-pump coronary artery bypass (OPCAB) have enrolled
selected patients and have not rigorously evaluated long-term graft patency.
A preliminary report showed OPCAB achieved improved inhospital outcomes, similar
completeness of revascularization, and shorter lengths of stay compared with
conventional coronary artery bypass grafting (CABG).
Objective To assess graft patency, clinical and quality-of-life outcomes, and
cost among patients while in the hospital and at 1-year follow-up.
Design, Setting, and Patients Randomized controlled trial of patients unselected for coronary anatomy,
ventricular function, or comorbidities between March 10, 2000, and August
20, 2001, at a US academic center. A total of 200 patients were enrolled;
3 patients were withdrawn after randomization for mitral valve repair or replacement.
Follow-up was complete for 197 patients at 30 days; 185 at 1 year.
Interventions One surgical session consisting of elective OPCAB or CABG with cardiopulmonary
bypass.The surgeon had extensive experience performing off-pump surgery; patients
were subsequently managed by blinded protocols.
Main Outcome Measures Coronary angiography documented graft patency prior to hospital discharge
and at 1 year; health-related quality of life; and cost of the index and subsequent
Results Graft patency was similar for OPCAB and conventional CABG with cardiopulmonary
bypass at 30 days (absolute difference, 1.3%; 95% confidence interval [CI],
−0.66% to 3.31%; P = .19) and at 1 year (absolute
difference, −2.2%; 95% CI, −6.1% to 1.7%; P = .27). Rates of death, stroke, myocardial infarction, angina, and
reintervention were similar at 30 days and 1 year. There were no significant
differences in health-related quality of life. Mean total hospitalization
cost per patient at hospital discharge was $2272 (95% CI, $755-$3732) less
for OPCAB (P = .002) and $1955 (95% CI, −$766
to $4727) less at 1 year (P = .08).
Conclusions In this randomized single-surgeon trial among unselected patients with
angiographic follow-up, OPCAB achieved similar graft patency in the hospital
and at 1 year. Cardiac outcomes and health-related quality of life at 30 days
and 1 year were similar and patients incurred a lower cost. OPCAB may provide
complete revascularization that is durable and cost-effective.
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