Off-pump coronary artery bypass graft surgery in California, 2003 to 2005

Zhongmin Li, Khung Keong Yeo, Joseph P. Parker, Geeta Mahendra, J Nilas Young, Ezra A Amsterdam

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: The impact of off-pump coronary artery bypass graft surgery (OPCAB) on operative mortality compared to conventional coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CCB) has not been clarified. Method: Patient clinical characteristics were compared between OPCAB and CCB for isolated CABG surgeries in 2003 to 2005 using data from the California CABG outcomes reporting program. A propensity score method and logistic regression models were used to compute propensity-adjusted operative mortality for patients undergoing OPCAB or CCB. Results: Of 57,284 isolated CABGs, 13,515 (22.9%) were OPCAB. Compared to CCB, OPCAB patients were older, more females/nonwhite, and had a higher prevalence of certain noncardiac risk factors but were fewer with diabetes, acute myocardial infarction, New York Heart Association class IV heart failure or angina, cardiogenic shock, prior cardiac surgery, left main coronary disease, or ≥3-vessel coronary disease (all P < .01). Overall, the propensity-adjusted operative mortalities (PAOMRs) were significantly lower in OPCAB patients compared to CCB patients (OPCAB 2.59% [95% CI 2.52%-2.67%] vs CCB 3.22% [95% CI 3.17%-3.27%]). Off-pump CABG had a protective advantage for all quintile subgroups (all P < .05). However, within the OPCAB cohort, those who converted to CCB intraoperately had higher PAOMR (converters 3.47% [95% CI 3.16%-3.77%] vs nonconverters 2.53% [95% CI 2.46%-2.61%]). Age, female sex, nonwhite race, diabetes, congestive heart failure, prior cadiac surgery, left main disease, and with ≥3 diseased coronary arteries were associated with a higher risk of intraoperative conversion from OPCAB to CCB (all <0.05). Conclusion: OPCAB and CCB patients had significantly different preoperative risk profiles, and OPCAB was associated with lower operative mortality compared to CCB.

Original languageEnglish (US)
Pages (from-to)1095-1102
Number of pages8
JournalAmerican Heart Journal
Volume156
Issue number6
DOIs
StatePublished - Dec 2008

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Off-Pump Coronary Artery Bypass
Coronary Artery Bypass
Cardiopulmonary Bypass
Transplants
Mortality
Coronary Disease
Heart Failure
Logistic Models
Propensity Score
Cardiogenic Shock

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Off-pump coronary artery bypass graft surgery in California, 2003 to 2005. / Li, Zhongmin; Yeo, Khung Keong; Parker, Joseph P.; Mahendra, Geeta; Young, J Nilas; Amsterdam, Ezra A.

In: American Heart Journal, Vol. 156, No. 6, 12.2008, p. 1095-1102.

Research output: Contribution to journalArticle

Li, Zhongmin ; Yeo, Khung Keong ; Parker, Joseph P. ; Mahendra, Geeta ; Young, J Nilas ; Amsterdam, Ezra A. / Off-pump coronary artery bypass graft surgery in California, 2003 to 2005. In: American Heart Journal. 2008 ; Vol. 156, No. 6. pp. 1095-1102.
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abstract = "Background: The impact of off-pump coronary artery bypass graft surgery (OPCAB) on operative mortality compared to conventional coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CCB) has not been clarified. Method: Patient clinical characteristics were compared between OPCAB and CCB for isolated CABG surgeries in 2003 to 2005 using data from the California CABG outcomes reporting program. A propensity score method and logistic regression models were used to compute propensity-adjusted operative mortality for patients undergoing OPCAB or CCB. Results: Of 57,284 isolated CABGs, 13,515 (22.9{\%}) were OPCAB. Compared to CCB, OPCAB patients were older, more females/nonwhite, and had a higher prevalence of certain noncardiac risk factors but were fewer with diabetes, acute myocardial infarction, New York Heart Association class IV heart failure or angina, cardiogenic shock, prior cardiac surgery, left main coronary disease, or ≥3-vessel coronary disease (all P < .01). Overall, the propensity-adjusted operative mortalities (PAOMRs) were significantly lower in OPCAB patients compared to CCB patients (OPCAB 2.59{\%} [95{\%} CI 2.52{\%}-2.67{\%}] vs CCB 3.22{\%} [95{\%} CI 3.17{\%}-3.27{\%}]). Off-pump CABG had a protective advantage for all quintile subgroups (all P < .05). However, within the OPCAB cohort, those who converted to CCB intraoperately had higher PAOMR (converters 3.47{\%} [95{\%} CI 3.16{\%}-3.77{\%}] vs nonconverters 2.53{\%} [95{\%} CI 2.46{\%}-2.61{\%}]). Age, female sex, nonwhite race, diabetes, congestive heart failure, prior cadiac surgery, left main disease, and with ≥3 diseased coronary arteries were associated with a higher risk of intraoperative conversion from OPCAB to CCB (all <0.05). Conclusion: OPCAB and CCB patients had significantly different preoperative risk profiles, and OPCAB was associated with lower operative mortality compared to CCB.",
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AU - Li, Zhongmin

AU - Yeo, Khung Keong

AU - Parker, Joseph P.

AU - Mahendra, Geeta

AU - Young, J Nilas

AU - Amsterdam, Ezra A

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N2 - Background: The impact of off-pump coronary artery bypass graft surgery (OPCAB) on operative mortality compared to conventional coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CCB) has not been clarified. Method: Patient clinical characteristics were compared between OPCAB and CCB for isolated CABG surgeries in 2003 to 2005 using data from the California CABG outcomes reporting program. A propensity score method and logistic regression models were used to compute propensity-adjusted operative mortality for patients undergoing OPCAB or CCB. Results: Of 57,284 isolated CABGs, 13,515 (22.9%) were OPCAB. Compared to CCB, OPCAB patients were older, more females/nonwhite, and had a higher prevalence of certain noncardiac risk factors but were fewer with diabetes, acute myocardial infarction, New York Heart Association class IV heart failure or angina, cardiogenic shock, prior cardiac surgery, left main coronary disease, or ≥3-vessel coronary disease (all P < .01). Overall, the propensity-adjusted operative mortalities (PAOMRs) were significantly lower in OPCAB patients compared to CCB patients (OPCAB 2.59% [95% CI 2.52%-2.67%] vs CCB 3.22% [95% CI 3.17%-3.27%]). Off-pump CABG had a protective advantage for all quintile subgroups (all P < .05). However, within the OPCAB cohort, those who converted to CCB intraoperately had higher PAOMR (converters 3.47% [95% CI 3.16%-3.77%] vs nonconverters 2.53% [95% CI 2.46%-2.61%]). Age, female sex, nonwhite race, diabetes, congestive heart failure, prior cadiac surgery, left main disease, and with ≥3 diseased coronary arteries were associated with a higher risk of intraoperative conversion from OPCAB to CCB (all <0.05). Conclusion: OPCAB and CCB patients had significantly different preoperative risk profiles, and OPCAB was associated with lower operative mortality compared to CCB.

AB - Background: The impact of off-pump coronary artery bypass graft surgery (OPCAB) on operative mortality compared to conventional coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass (CCB) has not been clarified. Method: Patient clinical characteristics were compared between OPCAB and CCB for isolated CABG surgeries in 2003 to 2005 using data from the California CABG outcomes reporting program. A propensity score method and logistic regression models were used to compute propensity-adjusted operative mortality for patients undergoing OPCAB or CCB. Results: Of 57,284 isolated CABGs, 13,515 (22.9%) were OPCAB. Compared to CCB, OPCAB patients were older, more females/nonwhite, and had a higher prevalence of certain noncardiac risk factors but were fewer with diabetes, acute myocardial infarction, New York Heart Association class IV heart failure or angina, cardiogenic shock, prior cardiac surgery, left main coronary disease, or ≥3-vessel coronary disease (all P < .01). Overall, the propensity-adjusted operative mortalities (PAOMRs) were significantly lower in OPCAB patients compared to CCB patients (OPCAB 2.59% [95% CI 2.52%-2.67%] vs CCB 3.22% [95% CI 3.17%-3.27%]). Off-pump CABG had a protective advantage for all quintile subgroups (all P < .05). However, within the OPCAB cohort, those who converted to CCB intraoperately had higher PAOMR (converters 3.47% [95% CI 3.16%-3.77%] vs nonconverters 2.53% [95% CI 2.46%-2.61%]). Age, female sex, nonwhite race, diabetes, congestive heart failure, prior cadiac surgery, left main disease, and with ≥3 diseased coronary arteries were associated with a higher risk of intraoperative conversion from OPCAB to CCB (all <0.05). Conclusion: OPCAB and CCB patients had significantly different preoperative risk profiles, and OPCAB was associated with lower operative mortality compared to CCB.

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