• Christian H Møller, Mario J Perko, Jens T Lund, Lars W Andersen, Henning Kelbæk, Jan K Madsen, Per Winkel, Christian Gluud, and Daniel A Steinbrüchel.
• Department of Cardio-Thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark. chm@ctu.rh.dk
• Heart. 2011 Jun 1;97(11):907-13.

ObjectiveTo evaluate off-pump versus on-pump coronary artery bypass grafting (CABG) in patients with three-vessel disease and a high-risk operative profile.DesignA randomised clinical trial.SettingRigshospitalet, University Hospital, Copenhagen, Denmark.Participants341 patients with three-vessel disease and a EuroSCORE of 5 or greater. Main exclusion criteria were previous heart surgery, poor left ventricular function (ejection fraction <30%), or unstable preoperative condition.InterventionCABG performed with versus without cardiopulmonary bypass.Main Outcome MeasureThe primary outcome was a composite of major adverse cardiac and cerebrovascular events (MACCE) including all-cause mortality, acute myocardial infarction, cardiac arrest with successful resuscitation, low cardiac output syndrome/cardiogenic shock, stroke and coronary reintervention.ResultsMACCE occurred in 69 (40%) patients allocated to off-pump versus 54 (33%) patients allocated to on-pump CABG during the median 3.7 years of follow-up (HR 1.22; 95% CI 0.86 to 1.75; p=0.26). All-cause mortality was significantly increased in the off-pump group (24% vs 15%; HR 1.66, 95% CI 1.02 to 2.73; p=0.04), but cardiac-related death was not significantly different (10% vs 7%; HR 1.30, 95% CI 0.64 to 2.66; p=0.47). An insignificant trend towards a reduction in myocardial infarction after off-pump CABG was observed (7% vs 14%; HR 0.53, 95% CI: 0.27 to 1.04; p=0.06).ConclusionsNo significant difference in the primary outcome of MACCE was found between off-pump and on-pump CABG. However, mortality seemed higher after off-pump CABG.Trial Registrationhttp://clinicaltrials.gov/number, NCT00120991.

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