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Outcomes Following Coronary Artery Bypass Grafting With Multiple Arterial Grafting By Pump Status In Men And Women
Yuan Qiu1, Fraser D. Rubens
1, Pierre Voisine
1, Stephen E. Fremes
2, Nicholas Grubic
3, Dean Fergusson
4, Monica Taljaard
4, Carl van Walraven
4
1University of Ottawa Heart Institute, Ottawa, ON, Canada, 2Sunnybrook Health Sciences Centre, Toronto, ON, Canada, 3Dalla Lana School of Public Health, Toronto, ON, Canada, 4School of Epidemiology and Public Health, Ottawa, ON, Canada
OBJECTIVE: Multiple arterial grafting (MAG) and off-pump surgery are strategies proposed to improve outcomes with coronary artery bypass grafting (CABG). It is unclear whether outcomes following MAG vary by pump status and whether such potential differences vary by patient sex. This study was conducted to determine the impact of off-pump surgery on outcomes after CABG with MAG in men and women.
METHODS: This cohort study used population-based data to identify all Ontarians undergoing isolated CABG with MAG between October 2008 and September 2019. The primary outcome was all-cause mortality. Secondary outcomes included major adverse cardiac and cerebrovascular events (MACCE; hospitalization for stroke, myocardial infarction hospitalization or heart failure, or repeat revascularization). Analysis used propensity-score overlap-weighted cause-specific Cox proportional hazard regression.
RESULTS: A total of 2989 women (1188 off-pump, 1801 on-pump) and 16,209 men (6065 off-pump, 10,144 on-pump) underwent MAG with a median follow-up of 5.0 years (interquartile range, 2.7-8.0) years. Compared to the on-pump approach, all-cause mortality was not changed with off-pump status (hazard ratio [HR] in women: 1.25 [95% CI, 0.83-1.88]; in men: 1.08 [95% CI, 0.85-1.37]). In women, the risk of MACCE was significantly higher off-pump (HR, 1.45; 95% CI, 1.04-2.03), with a nonsignificantly increased risk observed for all component outcomes.
CONCLUSIONS: In patients undergoing CABG with MAG, this population-based analysis found no association between pump status and survival in either men or women. However, it did suggest that off-pump MAG in women may be associated with an increased risk of MACCE.
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