Document Detail


Coronary artery bypass graft failure after on-pump and off-pump coronary artery bypass: findings from PREVENT IV.
MedLine Citation:
PMID:  18222251     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: This analysis compares 1-year vein graft patency and major adverse cardiac and cerebral events (MACCE [death, myocardial infarction, or stroke]) in on-pump and off-pump patients enrolled in PREVENT IV (the PRoject of Ex-vivo Vein graft ENgineering via Transfection IV). METHODS: The PREVENT IV was a multicenter (107 sites) randomized trial of edifoligide to prevent vein graft failure from neointimal hyperplasia in 3,014 patients undergoing primary, isolated coronary artery bypass grafting (CABG) with at least two vein grafts. One-year angiographic follow-up was completed on 1,920 patients (4,736 grafts) with MACCE follow-up on 99.4% of enrolled patients. RESULTS: In all, 2,377 procedures (78.9%) were on pump and 637 (21.1%) were off pump. On-pump patients had more chronic lung disease (17% versus 11%; p < 0.001), congestive heart failure (10% versus 7%; p = 0.03), lower mean ejection fraction (50% versus 55%; p < 0.001), and worse target artery quality (good 63.8% versus 68.1%; fair 26.4% versus 22.7%; poor 9.8% versus 9.2%; p < 0.001). Vein graft failure (more than 75% graft stenosis) in on- versus off-pump patients was 25.3% versus 25.7% (p = 0.62). After adjusting for differences in significant predictors of vein graft failure (target artery quality, surgery time, endoscopic vein harvest, more than 1 distal anastomosis/graft, and patient weight), the odds of vein graft failure was 0.82 (95% confidence interval: 0.67 to 1.00; p = 0.05) for on-pump versus off-pump patients. One-year mortality for on- versus off-pump patients was 3.3% versus 2.5% (p = 0.30); and MACCE was 15.4% versus 11.3% (p = 0.01). The adjusted hazard ratio for 1-year MACCE was 1.31 (95% confidence interval: 1.01-1.69; p = 0.01) for on pump versus off pump. CONCLUSIONS: Observed saphenous vein failure rate was 25% in both groups. One-year clinical outcomes (MACCE) were better with off-pump than with on-pump CABG, suggesting benefits not related to vein graft patency.
Authors:
Mitchell J Magee; John H Alexander; Gail Hafley; T Bruce Ferguson; C Michael Gibson; Robert A Harrington; Eric D Peterson; Robert M Califf; Nicholas T Kouchoukos; Morley A Herbert; Michael J Mack;
Publication Detail:
Type:  Clinical Trial, Phase III; Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  85     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-01-28     Completed Date:  2008-03-11     Revised Date:  2009-02-11    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  494-9; discussion 499-500     Citation Subset:  AIM; IM    
Affiliation:
Cardiopulmonary Research Science and Technology Institute, Dallas, Texas, USA. mmagee@csant.com
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MeSH Terms
Descriptor/Qualifier:
Age Distribution
Aged
Cardiopulmonary Bypass
Confidence Intervals
Coronary Angiography
Coronary Artery Bypass / methods*,  mortality
Coronary Artery Bypass, Off-Pump / methods
Coronary Stenosis / mortality,  radiography,  surgery*
Double-Blind Method
Female
Follow-Up Studies
Graft Occlusion, Vascular / epidemiology*,  radiography
Graft Rejection
Humans
Incidence
Male
Middle Aged
Odds Ratio
Predictive Value of Tests
Probability
Risk Assessment
Saphenous Vein / transplantation*
Severity of Illness Index
Sex Distribution
Survival Analysis
Comments/Corrections
Comment In:
Ann Thorac Surg. 2009 Feb;87(2):675-6; author reply 676   [PMID:  19161824 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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