Lots of interesting abstracts and cases were submitted for TCTAP 2023. Below are the accepted ones after a thorough review by our official reviewers. Don’t miss the opportunity to expand your knowledge and interact with authors as well as virtual participants by sharing your opinion in the comment section!
TCTAP A-039
On-Pump and Off-Pump Coronary Artery Bypass Grafting on 10-Year Mortality Versus Percutaneous Coronary Intervention
By Patrick W. Serruys, Shigetaka Kageyama, Kai Ninomiya, Neil O’Leary, Shinichiro Masuda, Nozomi Kotoku, Antonio Colombo, Robert Van Geuns, Michael J. Mack, Scot Garg, Yoshinobu Onuma
Presenter
Patrick W. Serruys
Authors
Patrick W. Serruys1, Shigetaka Kageyama1, Kai Ninomiya2, Neil O’Leary1, Shinichiro Masuda1, Nozomi Kotoku1, Antonio Colombo3, Robert Van Geuns4, Michael J. Mack5, Scot Garg6, Yoshinobu Onuma1
Affiliation
University of Galway, Ireland1, Iwate Medical University, Japan2, EMO GVM Centro Cuore Columbus, Italy3, Erasmus MC, Netherlands4, Baylor University Medical Center, USA5, Royal Blackburn Hospital, United Kingdom6
View Study Report
TCTAP A-039
Cardiac Surgery/Hybrid Revascularization
On-Pump and Off-Pump Coronary Artery Bypass Grafting on 10-Year Mortality Versus Percutaneous Coronary Intervention
Patrick W. Serruys1, Shigetaka Kageyama1, Kai Ninomiya2, Neil O’Leary1, Shinichiro Masuda1, Nozomi Kotoku1, Antonio Colombo3, Robert Van Geuns4, Michael J. Mack5, Scot Garg6, Yoshinobu Onuma1
University of Galway, Ireland1, Iwate Medical University, Japan2, EMO GVM Centro Cuore Columbus, Italy3, Erasmus MC, Netherlands4, Baylor University Medical Center, USA5, Royal Blackburn Hospital, United Kingdom6
Background
The very long-term mortality of off-pump and on-pump coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in a randomized complex coronary artery disease (CAD)population is unknown.
Methods
The SYNTAXES trial randomized 1800 patients with three-vessel and/or left main CAD to PCI or CABG and assessed their survival at10 years. In this sub-study, the hazard of mortality over 10 years was compared according to the technique of revascularization: on-pump CABG (n=725), off-pump CABG (n=128), and PCI (n=903).
Results
There was substantial inter-site variation in the use of off-pump CABG despite baseline characteristics being largely homogeneous amongst the three groups. The crude rate of mortality was significantly lower following on-pump CABG versus PCI (25.6% vs 28.4%, Hazard Ratio [HR] 0.79, 95%Confidence Interval [CI] 0.65-0.96), whilst it was comparable between off-pump CABG and PCI (28.5% vs 28.4%, HR 0.98, 95%CI 0.69-1.40). After adjusting for the nine variables included in the SYNTAX score II 2020, 10-year mortality remained significantly lower with on-pump CABG than PCI (HR 0.75 against PCI,p=0.009).
Conclusion
In the SYNTAXES trial, 10-year mortality adjusted for major confounders was significantly lower following on-pump CABG compared to PCI, whilst off-pump CABG offered no prognostic survival benefit over PCI. Siteheterogeneity in the technique used in bypass surgery has had measurable effects on treatment performance. Given its impact on outcomes, it should be-stratified in future studies.