Off-pump vs On-pump CABG in patients with ST segment elevation myocardial infarction: A randomized, double blind study
Khalil Fattouch, Giuseppe Bianco, Roberta Sampognaro, Egle Corrado, Pietro Dioguradi, Gaetano Panzarella, Giovanni Ruvolo; Cardiac Surgery, University of Palermo, Palermo, Italy
Comment on this Abstract
Objective: Emergency coronary artery bypass grafting (CABG) in patients with acute myocardial infarction (AMI) is still associated with high mortality and morbidity. Several retrospective studies suggested the benefits role of Off-pump surgery on in-hospital mortality and postoperative outcomes. This study was aimed to evaluate prospectively and randomly the impact of Off-pump vs On-pump CABG on early and midterm mortality and morbidity.
Methods: Sine February 2003, 128 patients with AMI underwent emergency CABG within 48 hours from onset of symptoms. Thrombolytic and/or primary PTCA therapies were applied or considered for all patients before surgery. Patients were randomly assigned in 2 groups (On-pump Group: 66 pts ( 51.5 %) and Off-pump Group: 62 pts ( 48.5 %)). A standardized CABG was performed in 2 groups. No statistical difference was found preoperatively between two groups except for gender, previous AMI, preoperative use of IABP. The mean number of grafts/patient was 2.8± 0.4 in the On-pump group and 2.6±0.5 in the Off-pump group. Follow-up was completed in all survivors. Mean follow-up was 22 ± 8 months.
Results: Overall in-hospital mortality was 4.6%. In-hospital mortality in the On-pump group was 7.7% (5 pts) compared to 1.6% (1 pt) in the Off-pump group (p=0.04). There were postoperative statistical significant difference between 2 groups with regard to incidence of low cardiac output syndrome (LCOS), use of inotrope drugs, time of mechanical ventilation, ICU and hospital stay, in On-pump group vs Off-pump group. The serum levels of Troponin I and CK-MB were most higher in On-pump group vs Off-pump group, during the first 48 hours from surgery. Variables such as hypertension, postoperative LCOS, high dose of inotrope drugs support, and On-pump emerged as predictors for in-hospital mortality (by multiple regression analysis). Preoperative PTCA and IABP use, time of CPB and use of high dose inotrope drugs emerged as predictors for postoperative ICU stay. There were no late deaths. All patients were free from recurrent angina and re-interventions (PTCA or surgery).
Conclusion: Off-pump CABG in patients with AMI is better than On-pump CABG in term of early mortality and morbidity. Our results suggests that CABG without CPB is effective in patients with AMI and can be performed safely with good results. Off-pump surgery could be challenge in this kind of patients and must be performed by experienced surgeons.
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