On-Pump Versus Off-Pump Coronary Artery Bypass Surgery in Elderly PatientsClinical Perspective: Results From the Danish On-Pump Versus Off-Pump Randomization Study

Background— Conventional coronary artery bypass grafting performed with the use of cardiopulmonary bypass is a well-validated treatment for patients with ischemic heart disease. Off-pump coronary artery bypass grafting (OPCAB) has been suggested to reduce the number of perioperative complications, especially in elderly patients. Methods and Results— In a multicenter, randomized trial, we assigned 900 patients >70 years of age to conventional coronary artery bypass grafting or OPCAB surgery. After 30 days, a blinded end-point committee assessed whether a combined end point of death, stroke, or myocardial infarction had occurred. At baseline and 6 months postoperatively, self-assessed quality of life was measured with the Medical Outcomes Study Short Form-36 and EuroQol-5D questionnaires. A 6-month follow-up of mortality was performed through the Danish National Registry. The proportion of patients experiencing the combined end point within 30 days was 10.2% for conventional coronary artery bypass grafting and 10.7% for OPCAB. Implied risk difference of 0.4% (with a 95% confidence interval, −3.6 to 4.4) showed nonsignificance in a standard test for equality ( P =0.83) and for noninferiority with an inferiority margin of 0.5% ( P =0.49). At the 6-month follow-up, mortality was 4.7% compared with 4.2% ( P =0.75). Both groups showed significant improvement in self-assessed health-related quality of life. Conclusions— Both conventional coronary artery bypass grafting and OPCAB are safe procedures that improved the quality of life when performed in elderly patients. No major differences in intermediate-term outcomes were found. However, the noninferiority of OPCAB with the prespecified margin could not be confirmed. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00123981.