Abstract 2883: Long-term Survival and Cardiac Troponin T Elevation in On- and Off-pump Coronary Artery Bypass Surgery

Abstract

Introduction: The long-term clinical usefulness of conventional coronary artery bypass graft surgery (CCAB) and off-pump surgery (OPCAB) remains controversial. Long-term survival and cardiac troponin T (cTnT) elevation following CCAB and OPCAB has not been assessed. We tested the hypothesis that long-term survival was similar for CCAB and OPCAB patients when stratified by the presence or absence of cTnT elevation. Methods: In this prospective cohort, we followed 1511 non-emergent patients with 2 or 3 vessel disease (778 CCAB and 733 OPCAB) from a single hospital in Northern New England by surgeons using both procedures between 2000–2004 to determine if 6-year survival was similar for CCAB and OPCAB patients. Postoperative cTnT elevation was defined at ≥1 (ng/μL). Data was linked to the Social Security Administration Death Master File. Kaplan-Meier and log-rank techniques were used. Cox’s proportional hazard models were used to calculate adjusted hazard ratios (HR) and 95% confidence intervals (95%CI), adjusting baseline patient and disease characteristics. Results: Patients were similar with regard to baseline disease characteristics, comorbidities, cardiac history, function and anatomy. CCAB was associated with higher 6-year survival compared with OPCAB regardless of troponin elevation (Figure , p<0.0001). Adjusted HR (CCAB cTnT <1 as referent) were 1.57 (1.05–2.36) for OPCAB cTnT<1, 1.52 (0.95–2.43) for CCAB cTnT ≥1, and 2.50 (1.37–4.58) for OPCAB cTnT≥1. Conclusion: In summary, CCAB results in better survival over OPCAB in patients presenting with two or three vessel disease undergoing non-emergent cardiac surgery.