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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAlthough coronary artery bypass grafting (CABG) is usually performed with the use of cardiopulmonary bypass (on-pump CABG), CABG without bypass (off-pump CABG) might reduce the number of major adverse events related to the heart-lung machine and improve outcomes. Investigators discussed the results of 3 studies - the GOPCABE study [Diegeler A et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2013, CORONARY study [Lamy A et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2013], and the PRAGUE 6 trial [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00606372\u0026amp;atom=%2Fspmdc%2F13%2F2%2F12.atom\u0022\u003ENCT00606372\u003C\/a\u003E] - that tested this hypothesis.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAlthough coronary artery bypass grafting (CABG) is usually performed with the use of cardiopulmonary bypass (on-pump CABG), CABG without bypass (off-pump CABG) might reduce the number of major adverse events related to the heart-lung machine (MACCRE) and improve outcomes. Investigators discussed the results of 3 studies that tested this hypothesis.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EGERMAN OFF-PUMP CORONARY ARTERY BYPASS IN THE ELDERLY [GOPCABE] STUDY\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EAnno Diegeler, MD, PhD, University of Leipzig\/Herz-und Gef\u00e4ssklinik GmbH, Abteilung Herzchirurgie, Bad Neustadt, Germany, presented the results of the GOPCABE study [Diegeler A et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2013], which showed no significant difference in clinical outcome between the 2 approaches at 30 days and at 12 months.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EIn GOPCABE, patients aged \u226575 years who were scheduled for elective first-time CABG were randomly assigned to off-pump (n=1271) or on-pump surgery (n=1268). The primary endpoint was a composite of death, myocardial infarction (MI), additional revascularization, stroke, and new onset renal replacement therapy 30 days after surgery.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EAt 30 days, the primary composite endpoint was not significantly different between the 2 treatments (7.8% for off-pump vs 8.2% for on-pump; OR, 0.95; 95% CI, 0.71 to 1.28; p=0.74). Of the components of the primary endpoint, only the repeat revascularization rate was significantly different and favored the traditional on-pump technique (1.3% vs 0.4%, respectively; p=0.04).\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EThe investigators noted no significant differences between the 2 groups for the primary composite endpoint or repeat revascularization at 12 months. The results were similar in a per-protocol analysis that excluded the 177 patients who had crossed over from their assigned treatment to the other treatment. A potential limitation of this study was that it was a modified intent-to-treat analysis and only local data confirmation was performed.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ECORONARY ARTERY BYPASS SURGERY OFF- OR ON-PUMP REVASCULARIZATION [CORONARY] STUDY\u003C\/h2\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EAndr\u00e9 Lamy, MD, MHSc, McMaster University, Hamilton, Ontario, Canada, reported the 1-year results of the CORONARY study [Lamy A et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2013]. The 30-day results have been previously published [Lamy A et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2012]. As with GOPCABE, the investigators found no significant differences in the primary composite outcome or in the occurrence of major clinical events between the 2 groups.\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EThe study was conducted in 4752 patients (aged \u226570 years or younger patients with risk factors) from 79 sites in 19 countries. It utilized a surgical expertise-based design, whereby only surgeons considered to have expertise in the specific type of surgery were assigned to perform that procedure. Patients were randomly assigned to off-pump (n=2375) or on-pump CABG (n=2377). Clinical outcomes were assessed at 1 year. Quality of life and cognitive function were assessed at discharge, 30 days, and 1 year.\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EThe primary composite endpoint (death, nonfatal stroke, nonfatal MI, or nonfatal new renal failure requiring dialysis) was not significantly different between off-pump (12.1%) and on-pump procedures (13.3%; HR, 0.91; 95% CI, 0.77 to 1.07; p=0.24). There were no individual differences between the 2 groups in the primary endpoint components, rate of revascularization procedures, quality of life, neurocognitive functions, or in any of the subgroup analyses.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EThe authors noted that, based on mid-term results, both procedures are reasonable options when in experienced hands.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EON-PUMP VERSUS OFF-PUMP CABG IN HIGH-RISK PATIENTS EUROSCORE 6+ [PRAGUE6] STUDY\u003C\/h2\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EThe PRAGUE 6 trial [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00606372\u0026amp;atom=%2Fspmdc%2F13%2F2%2F12.atom\u0022\u003ENCT00606372\u003C\/a\u003E] results indicated that off-pump surgery in high-risk patients is associated with a lower incidence of serious complications and is a safer way of direct revascularization in these patients. Jan Hlavicka, MD, Kralovske Vinohrady University Hospital, Prague, Czech Republic, presented the findings of this prospective, randomized, single center, intention-to-treat assessment study.\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EThe primary endpoint was the composite of death, MI, stroke, and new renal failure requiring hemodialysis at 30 days post operation. Patients were mean age 74 years with a mean additive EuroSCORE (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E) of 7.7; approximately 64% of the 206 enrolled patients had a recent MI. A total of 206 patients were randomly assigned to off-pump (n=98) or on-pump CABG (n=108).\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/13114\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/13114\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13114\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-13\u0022 class=\u0022first-child\u0022\u003EEuroSCORE Risk Assessment Criteria\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-15\u0022\u003EAt 30 days, the primary composite endpoint was significantly lower in the off-pump (9.2%) versus on-pump group (20.6%; HR, 0.41; 95% CI, 0.19 to 0.91; p=0.028; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E), driven exclusively by a nearly 3-fold increase in the rate of MI between the off-pump and on-pump groups (4.1% vs 12.1%; HR, 0.32; 95% CI, 0.11 to 0.99; p=0.048). Off-pump patients tended to have a lower incidence of secondary endpoints (eg, need for red blood cell transfusion and re-exploration for bleeding or tamponade). Study limitations included the small number of patients, single-center design, use of only 5 surgeons, and short-term (30-day follow-up) results.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/2\/12\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Incidence of Combined Primary Endpoint During First 30 Days\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1405887325\u0022 data-figure-caption=\u0022Incidence of Combined Primary Endpoint During First 30 Days\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/2\/12\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/2\/12\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/2\/12\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13112\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-16\u0022 class=\u0022first-child\u0022\u003EIncidence of Combined Primary Endpoint During First 30 Days\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from Hlavicka, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-17\u0022\u003ETaken together, the conflicting results of these 3 studies (2 showed no difference, 1 favored off-pump CABG) indicate a need for larger, well-controlled studies with longer follow-up. Of particular interest is whether there are patients for whom one approach may be safer than the other.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/2\/12.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzo0i1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzo0i1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzo0i1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}