Comparison of the immediate results after off-pump and on-pump coronary artery bypass grafting in patients with acute coronary syndromes

Authors: Zhalilov A.K., Merzlyakov V.Yu., Klyuchnikov I.V., Salomov M.A., Khaziev R.A., Berdibekov B.Sh.

Company: 1Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation
2 Republican Specialized Scientific and Practical Medical Center of Cardiology. Karshi Branch in Karshi, Uzbekistan

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2023-17-2-256-271

For citation: Zhalilov A.K., Merzlyakov V.Yu., Klyuchnikov I.V., Salomov M.A., Khaziev R.A., Berdibekov B.Sh. Comparison of the immediate results after off-pump and on-pump coronary artery bypass grafting in patients with acute coronary syndromes. Creative Cardiology. 2023; 17 (2): 256–71 (in Russ.). DOI: 10.24022/1997-3187-2023-17-2-256-27

Received / Accepted:  02.05.2023 / 22.05.2023

Keywords: coronary artery bypass grafting acute coronary syndrome myocardial infarction off-pump coronary artery bypass

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Abstract

Objective. To study the efficacy, safety, and short-term results after off-pump (OPCAB) and conventional onpump coronary artery bypass (ONCAB) in patients with acute coronary syndrome (ACS).

Material and methods. We retrospectively analyzed a consecutive series of 187 patients who underwent CCAB and 220 patients who underwent OPCAB for ACS. The average age of the patients was 59.8±7.9 years, mainly men 204 (83.6%). Propensity score matching (1:1) was applied to adjust for differences in baseline clinical and angiographic characteristics, yielding a total of 262 matched patients with ACS. The primary outcome was in-hospital mortality, repeated myocardial revascularization, myocardial infarction (MI), postoperative cerebrovascular accidents (stroke, transient ischemic attack (TIA)), as well as a composite outcome of in-hospital mortality, repeated myocardial revascularization, MI, and postoperative cerebrovascular accidents.

Results. There was no significant difference between off-pump and on-pump coronary artery bypass grafting (CABG) in the rate of in-hospital mortality (2.3% and 3.1%, respectively; p=1.00), perioperative stroke (0.8% and 3.8%, respectively; p=0.21), TIA (1.5% and 0.8%, respectively; p=1.00), MI (3.1% and 6.2%, respectively; p=0.25), and repeated myocardial revascularization (0.8% and 0.8%, respectively; p=1.00). However, the rate of the composite outcome was higher for on-pump than for off-pump CABG (13.0 vs. 5.3%, p=0.03). In multivariate regression analysis, age (odds ratio (OR) 1.07; 95% confidence interval (CI) (1.01–1.13); p=0.03), Logistic EuroSCORE II (OR 1.21; 95% (CI (1.02–1.42); p=0.02), and OPCAB (OR 0.34; 95% CI (0.13–0.90); p=0.03) demonstrated an independent association with the composite outcome. Furthermore, 67.9% of patients in the OPCAB group and 77.9% in the CCAB group underwent intraoperative shuntography, which revealed mechanical complications of the shunt in 15 (11.5%) and 11 (8.4%) cases, respectively (p=0.408).

Conclusion. This study provided further evidence on the safety and efficacy of OPCAB in the treatment of patients with ACS who underwent CABG.

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About Authors

  • Adkham K. Zhalilov, Cand. Med. Sc., Applicant of Bakoulev NMRC CS, Cardiac Surgeon, Head of Department of RSS PMCC, Karshi Branch; ORCID
  • Vadim Yu. Merzlyakov, Dr. Med. Sci., Head of Department, Cardiac Surgeon; ORCID
  • Ivan V. Klyuchnikov, Dr. Med. Sci., Professor, Chief Researcher, Cardiologist; ORCID
  • Makhmadsharif A. Salomov, Researcher, Cardiac Surgeon; ORCID
  • Ruslan A. Khaziev, Cardiac Surgeon; ORCID
  • Bektur Sh. Berdibekov, Researcher, Cardiologist; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery