Cognitive and cardiac outcomes 5 years after off-pump vs on-pump coronary artery bypass graft surgery

被引:203
作者
van Dijk, Diederik
Spoor, Monique
Hijman, Ron
Nathoe, Hendrik M.
Borst, Cornelius
Jansen, Erik W. L.
Grobbee, Diederick E.
de Jaegere, Peter P. T.
Kalkman, Cor J.
机构
[1] Univ Med Ctr Utrecht, Div Perioperat & Emergency Care, Dept Anesthesiol, NL-3508 GA Utrecht, Netherlands
[2] Univ Med Ctr Utrecht, Dept Psychiat, NL-3508 GA Utrecht, Netherlands
[3] Univ Med Ctr Utrecht, Dept Cardiol, NL-3508 GA Utrecht, Netherlands
[4] Univ Med Ctr Utrecht, Dept Cardiothorac Surg, NL-3508 GA Utrecht, Netherlands
[5] Univ Med Ctr Utrecht, Julius Ctr Patient Oriented Res, NL-3508 GA Utrecht, Netherlands
[6] Erasmus MC, Dept Cardiol, Rotterdam, Netherlands
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2007年 / 297卷 / 07期
关键词
D O I
10.1001/jama.297.7.701
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context Conventional coronary artery bypass graft surgery with use of cardiopulmonary bypass (on-pump CABG) is associated with excellent long-term cardiac outcomes but also with a high incidence of cognitive decline. The effect of avoiding cardiopulmonary bypass (off-pump CABG) on long-term cognitive and cardiac outcomes is unknown. Objective To compare the effect of off-pump CABG and on-pump CABG surgery on long-term cognitive and cardiac outcomes. Design, Setting, and Participants The Octopus Study, a multicenter randomized controlled trial conducted in the Netherlands, which enrolled 281 low-risk CABG patients between 1998 and 2000. Five years after their surgery, surviving patients were invited for a follow-up assessment. Intervention Patients were randomly assigned to receive either off-pump (n = 142) or on-pump (n = 139) CABG surgery. Main Outcome Measure The primary measure was cognitive status 5 years after surgery, which was determined by a psychologist blinded to treatment allocation who administered 10 standardized validated neuropsychological tests. Secondary measures were occurrence of cardiovascular events (all-cause mortality, stroke, myocardial infarction, and coronary reintervention), anginal status, and quality of life. Results After 5 years, 130 patients were alive in each group. Cognitive outcomes could be determined in 123 and 117 patients in the off-pump and on-pump groups, respectively. When using a standard definition of cognitive decline (20% decline in performance in 20% of the neuropsychological test variables), 62 (50.4%) of 123 in the off-pump group and 59 (50.4%) of 117 in the on-pump group had cognitive decline (absolute difference, 0%; 95% confidence interval [CI], -12.7% to 12.6%; P > .99). When a more conservative definition of cognitive decline was used, 41 (33.3%) in the off-pump group and 41 (35.0%) in the on-pump group had cognitive decline (absolute difference, -1.7%; 95% CI, -13.7% to 10.3%; P = .79). Thirty off-pump patients (21.1%) and 25 on-pump patients (18.0%) experienced a cardiovascular event (absolute difference, 3.1%; 95% CI, -6.1% to 12.4%; P = .55). No differences were observed in anginal status or quality of life. Conclusion In low-risk patients undergoing CABG surgery, avoiding the use of cardiopulmonary bypass had no effect on 5-year cognitive or cardiac outcomes.
引用
收藏
页码:701 / 708
页数:8
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