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Five‐Year Outcomes after On‐Pump and Off‐Pump Coronary‐Artery Bypass

Background Coronary‐artery bypass grafting (CABG) surgery may be performed either with cardiopulmonary bypass (on pump) or without cardiopulmonary bypass (off pump). We report the 5‐year clinical outcomes in patients who had been included in the Veterans Affairs trial of on‐pump versus off‐pump CABG. Methods From February 2002 through June 2007, we randomly assigned 2203 patients at 18 medical centers to undergo either on‐pump or off‐pump CABG, with 1‐year assessments completed by May 2008. The two primary 5‐year outcomes were death from any cause and a composite outcome of major adverse cardiovascular events, defined as death from any cause, repeat revascularization (CABG or percutaneous coronary intervention), or nonfatal myocardial infarction. Secondary 5‐year outcomes included death from cardiac causes, repeat revascularization, and nonfatal myocardial infarction. Primary outcomes were assessed at a P value of 0.05 or less, and secondary outcomes at a P value of 0.01 or less. Results The rate of death at 5 years was 15.2% in the off‐pump group versus 11.9% in the on‐pump group (relative risk, 1.28; 95% confidence interval [CI], 1.03 to 1.58; P=0.02). The rate of major adverse cardiovascular events at 5 years was 31.0% in the off‐pump group versus 27.1% in the on‐pump group (relative risk, 1.14; 95% CI, 1.00 to 1.30; P=0.046). For the 5‐year secondary outcomes, no significant differences were observed: for nonfatal myocardial infarction, the rate was 12.1% in the off‐pump group and 9.6% in the on‐pump group (P=0.05); for death from cardiac causes, the rate was 6.3% and 5.3%, respectively (P=0.29); for repeat revascularization, the rate was 13.1% and 11.9%, respectively (P=0.39); and for repeat CABG, the rate was 1.4% and 0.5%, respectively (P=0.02). Conclusions In this randomized trial, off‐pump CABG led to lower rates of 5‐year survival and event‐free survival than on‐pump CABG. (Funded by the Department of Veterans Affairs Office of Research and Development Cooperative Studies Program and others; ROOBY‐FS ClinicalTrials.gov number, NCT01924442.)