Long-Term Survival and Mortality Predictors of Off-Pump vs On-Pump Coronary Artery Bypass Grafting: A 25-Year Cohort Study.

BACKGROUND

Coronary artery bypass grafting (CABG), a key procedure for managing severe coronary artery disease, is performed by 2 primary surgical strategies: off-pump CABG and on-pump CABG. The long-term survival impact of off-pump CABG compared with on-pump CABG remains debated because of conflicting evidence. This study compared 25-year survival rates between off-pump CABG and on-pump CABG and identified key predictors of long-term mortality in CABG patients.

METHODS

A retrospective cohort study analyzed 13,626 patients who underwent isolated CABG from January 1996 to September 2023. Patients were divided into off-pump CABG (n = 7408) and on-pump CABG (n = 6218) groups. Propensity score matching minimized baseline differences, yielding a matched cohort of 11,368 patients (5684 per group). Kaplan-Meier survival analysis was used to compare long-term survival between groups, and Cox proportional hazards regression identified independent predictors of mortality.

RESULTS

Off-pump CABG demonstrated superior 25-year survival (unmatched, 58.2% vs 42.2% [P < .001]; matched, 57.5% vs 42.7% [P < .001]), with benefits increasing beyond 10 years. Predictors of reduced survival included older age, heart failure, prior myocardial infarction, severe chronic kidney disease, previous cardiac surgery, diabetes, lung disease, stroke, atrial fibrillation, and use of vein-only grafts. Off-pump CABG was independently associated with improved survival (hazard ratio, 0.625; 95% CI, 0.574-0.664; P < .001).

CONCLUSIONS

Off-pump CABG is associated with superior long-term survival compared with on-pump CABG, with the survival gap widening over time. Identifying high-risk patients on the basis of demographic and comorbid factors can optimize surgical decision-making and guide revascularization strategies.