What are the long-term outcomes of off-pump versus on-pump coronary artery bypass grafting surgery?

In this 5-year follow-up study of the Randomized On/Off Bypass (ROOBY) trial, patients who received off-pump coronary artery bypass grafting (CABG) had increased all-cause mortality as compared with those who received on-pump CABG. (LOE = 1b)

Shroyer AL, Hattler B, Wagner TH, et al, for the Veterans Affairs ROOBY-FS Group. Five-year outcomes after on-pump and off-pump coronary-artery bypass. N Engl J Med 2017;377(7):623-632.  [PMID:28813218]

Randomized controlled trial (single-blinded)

Government

Concealed

Inpatient (any location) with outpatient follow-up

Off-pump CABG refers to performing this surgery without the use of cardiopulmonary bypass. The 1-year results from the original ROOBY trial performed at multiple Veterans Affairs hospitals showed an increase in major adverse cardiovascular events—a composite outcome of all-cause deaths, nonfatal acute myocardial infarctions, or repeat revascularization procedures—in the off-pump group as compared with the on-pump group. In the current follow-up study, investigators report the 5-year outcomes. The original trial randomized 2203 patients to receive either off-pump or on-pump CABG. Follow-up data was available for 99% of participants and all 2203 were included in the 5-year intention-to-treat analysis. For the first primary outcome of all-cause mortality, the off-pump group had significantly more deaths than the on-pump group (15.2% vs 11.9%; P = .02). The off-pump group also fared worse in the second primary outcome of major adverse cardiovascular events (31% vs 27.1%; P = .046). There were no significant differences in deaths from cardiac causes, acute myocardial infarctions, or repeat revascularization procedures.