Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting

Saturday, December 17, 2016

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Source

Source Name: NEJM

Source URL: http://www.nejm.org/doi/full/10.1056/NEJMoa1601564?query=featured_home

Author(s)

André Lamy, M.D., P.J. Devereaux, M.D., Ph.D., Dorairaj Prabhakaran, M.D., David P. Taggart, Ph.D., Shengshou Hu, M.D., Zbynek Straka, M.D., Leopoldo S. Piegas, M.D., Alvaro Avezum, M.D., Ahmet R. Akar, M.D., Fernando Lanas Zanetti, M.D., Anil R. Jain, M.D., Nicolas Noiseux, M.D., Chandrasekar Padmanabhan, M.D., Juan-Carlos Bahamondes, M.D., Richard J. Novick, M.D., Liang Tao, M.D., Pablo A. Olavegogeascoechea, M.D., Balram Airan, M.D., Toomas-Andres Sulling, M.D., Richard P. Whitlock, M.D., Yongning Ou, M.Sc., Peggy Gao, M.Sc., Shirley Pettit, R.N., and Salim Yusuf, D.Phil., for the CORONARY Investigators*

This study is the 5-year follow-up of a large randomized controlled trial of on-pump CABG vs. OPCAB performed by seasoned surgeons. A total of 4,752 patients were included in this trial. At 5 years of follow-up, there was no difference between the groups in either the composite outcome of death, stroke, MI, or renal failure or between any of the individual components.

Question: There appears to be equipoise between either technique for coronary revascularization at 5 years. Are these results determinative? Is there any further information we need? Or, does this settle the issue once and for all?

Comments

Submitted by Kyriacos Kolocassides on Tue, 2016-12-27 17:30

Since this reported 5 year results, the only end points we should be interested in are the reasons we operate in the first place. Thus these are (i) symptomatic relief, and (ii) a survival advantage. These can be the only valid end points, la raison d'être. Although repeat revascularisation addressed (i) cases of failure of medical therapy, we have no information on medical therapy reintroduction for angina, and quality of life measures do not include this. I do not see quality of life measures to be useful anyway, as these patients received further therapy eg repeat revascularisation or medical therapy after surgery. Regarding (ii) it is too early to comment, I am sure you will agree.