Objective

Off-pump coronary artery bypass provides good quality graft on left anterior descending without exposing the patient to cardiopulmonary bypass, and, despite providing an incomplete revascularization, might be ideal in high-risk patients, not eligible to percutaneous or on-pump procedures. Aim of this study was to compare survival in high-risk patients with multi vessel disease and no percutaneous option, treated with incomplete off-pump revascularization or discharged on optimal medical therapy

Methods

83 high-risk patients with multi-vessel disease (MVD) were enrolled: 42 were treated with incomplete off-pump (OPCAB) revascularization using left internal mammary artery (LIMA) to LAD; 41 were treated with optimal medical therapy (OMT), having refused surgery. Patients were followed-up by telephone interview. Primary endpoint was survival from all-cause mortality; secondary endpoints were survival from cardiac-related mortality and freedom from non-fatal major adverse cardiac events (MACE).

Results

During follow up, there were 11 deaths in OPCAB group and 27 deaths in OMT group (P<0.001). Death was due to cardiac factors in 6 and 15 patients, respectively. Both survival from all-cause mortality and cardiac-related events were in favour of the OPCAB group over the OMT which carried a propensity score-adjusted hazard ratio of 3.862 and 3.663 (P<0.001), for all-cause and cardiac-related mortality respectively. There was no statistically significant difference concerning freedom from MACE.

Conclusion

For high-risk patients with MVD, considered ineligible for on-pump complete revascularization surgery or percutaneous coronary intervention, incomplete revascularization with OPCAB LIMA-on-LAD offers benefits in survival when compared to OMT alone.