Outcomes of Off-Pump versus On-Pump Coronary Artery Bypass Surgery in End-Stage Renal Disease Patients with a History of Myocardial Infarction

Authors

  • Graham J. Moore
  • Gregory D. Trachiotis

DOI:

https://doi.org/10.1532/HSF98.20061073

Abstract

Background. Patients with end-stage renal disease (ESRD) and myocardial infarction (MI) have poor survival. Coronary artery bypass grafting (CABG) in select patients is an effective treatment strategy; however, whether operative technique influences hospital outcome is not defined.

Methods. Between 1995 and 2000, 342 patients had ESRD (creatinine >2.0 mg/dL or dialysis) and a history of MI at the time of CABG. There were 67 patients that had off-pump coronary artery bypass (OPCAB) (OFF) and 275 that had CABG (ON). The OFF group was compared to the ON group for clinical, operative, outcome data, and influence of acuity of MI.

Results. The OFF group was older (P = .09), but hypertension was more common in the ON group (82% versus 69%, P = .02). The frequency of diabetes, congestive heart failure, peripheral vascular disease, and dyslipidemia were common, but not different between groups. For the OFF versus ON group, creatinine serum level was 3.6 ± 2.6 versus 3.5 ± 3.1 (P = 0.17), and history of an acute MI was 39% versus 33% (P = 0.78). The OFF versus ON group had fewer total grafts (2.5 ± 1 versus 3.8 ± 1, P < .001). The OFF group had fewer strokes (P = .08), shorter intensive care unit stay (2.4 versus 3.8 days), and shorter hospitalization (8.4 versus 11.7 days), yet mortality was similar (7% versus 9%, P = .79). After acute MI, OFF patients had significantly more postoperative supraventricular tachycardia than ON (69% versus 19%, P < .001).

Conclusions. Patients with ESRD and an MI have acceptable hospital outcomes regardless of operative strategy. OPCAB or CABG may provide an advantage in certain patients, yet it is the presence of an acute MI that is a predictor of postoperative events.

References

Ascione R, Lloyd CT, Underwood MJ, et al. 1999. On-pump versus off-pump coronary revascularization: evaluation of renal function. Ann Thorac Surg 68:493-8.nCollins AJ, Li S, Ma JZ, Herzog C. 2001. Cardiovascular disease in end-stage renal disease patients. Am J Kidney Dis 38(4 suppl 1):S26-9.nHerzog CA, Ma JZ, Collins AJ. 1998. Poor long-term survival after acute myocardial infarction among patients on long-term dialysis. N Engl J Med 339:799-805.nHerzog CA, Ma JZ, Collins AJ. 1999. Long-term outcome of dialysis patients in the United States with coronary revascularization procedures. Kidney Int 56:324-32.nHerzog CA, Ma JZ, Collins AJ. 2002. Comparative survival of dialysis patients in the United States after coronary angioplasty, coronary artery stenting, and coronary artery bypass surgery and impact of diabetes. Circulation 106:2207-11.nLiu JY, Birkmeyer NJ, Sanders JH, et al. 2000. Risks of morbidity and mortality in dialysis patients undergoing coronary artery bypass surgery. Northern New England Cardiovascular Disease Study Group. Circulation 102:2973-7.nLoef BG, Epema AH, Navis G, et al. 2002. On-pump coronary revascularization attenuates transient renal damage compared with off-pump coronary revascularization. Chest 121:1190-4.nMoore GJ, Pfister A, Trachiotis GD. 2005. Outcomes for off-pump coronary artery bypass grafting in high-risk groups: a historical perspective. Heart Surg Forum 8:E19-22.nOwen CH, Cummings RG, Sell TL, Schwab SJ, Jones RH, Glower DD. 1994. Coronary artery bypass grafting in patients with dialysis-dependent renal failure. Ann Thorac Surg 58:1729-33.nRao V, Weisel RD, Buth KJ, et al. 1997. Coronary artery bypass grafting in patients with non-dialysis-dependent renal insufficiency. Circulation 96(suppl II):II38-45nSarnak MJ, Levey AS, Schoolwerth AC, et al. 2003. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation 108:2154-69.nSzczech LA, Best PJ, Crowley E, et al. 2002. Outcomes of patients with chronic renal insufficiency in the bypass angioplasty revascularization investigation. Circulation 105:2253-8.nTrachiotis GD, Hanumara D, McKenna L, et al. 2003. Surgical revascularization after acute myocardial infarction in patients with end-stage renal disease. Presentation at the 2nd European Association of Cardio-Thoracic Surgery (EACTS)/European Society of Thoracic Surgery (ESTS) Joint Meeting, Vienna, Austria, 12-15 October 2003.nTrachiotis GD, Margolis M, Pfister A, et al. 2001. Coronary artery bypass grafting off-pump (OPCAB) in patients with renal failure. Heart Surg Forum 4(suppl II);S119.nVaitkus PT. 2000. Current status of prevention, diagnosis, and management of coronary artery disease in patients with kidney failure. Am Heart J 139:1000-8.n

Published

2006-07-14

How to Cite

Moore, G. J., & Trachiotis, G. D. (2006). Outcomes of Off-Pump versus On-Pump Coronary Artery Bypass Surgery in End-Stage Renal Disease Patients with a History of Myocardial Infarction. The Heart Surgery Forum, 9(5), E774-E778. https://doi.org/10.1532/HSF98.20061073

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