Ten-year outcomes after off-pump versus on-pump coronary artery bypass grafting: Insights from the Arterial Revascularization Trial

AbstractObjective We performed a post hoc analysis of the Arterial Revascularization Trial to compare 10-year outcomes after off-pump versus on-pump surgery. Methods Among 3102 patients enrolled, 1252 (40% total) and 1699 received surgery (151 were excluded because other reasons); 2792 (95%) completed follow-up. Propensity matching mixed-effect Cox model used long-term outcomes. Interaction term was determine whether bilateral internal thoracic artery grafting significant effect modifier. Results One thousand seventy-eight matched pairs selected for comparison. A total 27 (2.5%) in group required conversion The groups similar number grafts (3.2 ± 0.89 vs 3.1 0.8; P = .88). At 10 years, when compared with on-pump, there no difference death (adjusted hazard ratio off-pump, 1.1; 95% confidence interval, 0.84-1.4; .54) or composite death, myocardial infarction, stroke, repeat revascularization ratio, 0.92; 0.72-1.2; .47). However, by low volume surgeons associated significantly lower grafts, increased rates, cardiovascular (hazard 2.39; 1.28-4.47; .006) on–pump-only surgeons. Conclusions findings showed that Trial, techniques achieved comparable low-volume surgeons, it conversion, higher risk death.