At 30 days, there was no difference between the off-pump and on-pump groups in the coprimary outcome components of death (2.5% for both; hazard ratio, 1.02), stroke (1.0% vs 1.1%; HR, 0.89), nonfatal MI (6.7% vs. 7.2%; HR, 0.93), and new renal failure (1.2% vs. 1.1%; HR, 1.04).
Respiratory infection or failure was reported in 6% of the off-pump group and 7.5% of the on-pump group (P = .03; relative risk, 0.79), acute kidney injury stage 1 in 28% vs. 32% (P = .01; RR, 0.87) and RIFLE (risk, injury, failure, loss, and end-stage kidney disease) risk in 17% vs. 19.6% (P = .02; RR, 0.87), he said.
A subgroup analysis found no differences between the two techniques by age, cerebrovascular or peripheral arterial disease, EuroSCORE, left ventricular ejection fraction, region, or experience of the surgeon, Dr. Lamy said.
Both approaches are valid, and surgeons will need to tailor surgery for each individual patient, he said in an interview. For example, the off-pump technique may be best in a frail elderly patient to avoid transfusions and massive fluid infusion, whereas the on-pump technique may be best for a very large patient with the heart deeply placed within the chest.
Neurological outcomes and a cost-effectiveness analysis will be forthcoming. Five-year data on the coprimary end point plus repeat coronary revascularization over 5 years of follow-up are expected in 2016, Dr. Lamy said.
This study is funded by the Canadian Institutes of Health Research. Dr. Lamy reported consulting fees and honoraria from AstraZeneca.