Role of coronary collaterals in off-pump and on-pump coronary bypass surgery

H.M. Nathoe; Erik Buskens; E.W.L. Jansen; W.J.L. Suyker; P.R. Stella; J.R.  Lahpor; W.J. van Boven; D. van Dijk; J.C. Diephuis; C. Borst; K.G.M. Moons; D.E. Grobbee; P.P.T. de Jaegere

doi:10.1161/01.CIR.0000143105.42988.FD

Role of coronary collaterals in off-pump and on-pump coronary bypass surgery

H.M. Nathoe, Erik Buskens, E.W.L. Jansen, W.J.L. Suyker, P.R. Stella, J.R. Lahpor, W.J. van Boven, D. van Dijk, J.C. Diephuis, C. Borst, K.G.M. Moons, D.E. Grobbee, P.P.T. de Jaegere

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Collaterals limit infarct size, preserve viability, and reduce mortality in patients with acute myocardial infarction. In patients with stable coronary disease, collaterals are associated with less angina and ischemia during angioplasty and fewer ischemic events during follow-up. The role of collaterals has not been studied in patients undergoing off-pump or on-pump bypass surgery.

METHODS AND RESULTS: The population consisted of the 281 patients randomized to off-pump or on-pump CABG in the Octopus Study. Collaterals were defined on the baseline angiogram with the Rentrop score and were present in 49% and 51% of the patients in the off-pump and on-pump group, respectively. Perioperative myocardial infarction was defined by a creatine kinase-MB to CK ratio >10% and occurred in 18.2% in the off-pump group and 32.5% in the on-pump group. The unadjusted OR of perioperative myocardial infarction in the presence of collaterals was 0.31 (95% CI 0.17 to 0.84) in the off-pump group and 1.06 (95% CI 0.29 to 3.85) in the on-pump group After adjustment for age, gender, hypertension, hypercholesterolemia, diabetes, multivessel disease, ventricular dysfunction, incomplete revascularization, and ischemic time, the OR was 0.34 (95% CI 0.14 to 0.84) in the off-pump group and 1.28 (95% CI 0.30 to 5.40) in the on-pump group, respectively. Kaplan-Meier estimates of event-free survival at 1 year were 87% in patients with and 69% in those without collaterals after off-pump CABG. These estimates were 66% and 63%, respectively, after on-pump CABG.

CONCLUSIONS: Collaterals protect against perioperative myocardial infarction during off-pump surgery but not during on-pump surgery and are associated with a better 1-year event-free survival.

Original language	English
Pages (from-to)	1738-1742
Number of pages	5
Journal	Circulation
Volume	110
Issue number	13
DOIs	https://doi.org/10.1161/01.CIR.0000143105.42988.FD
Publication status	Published - 28 Sept 2004

Keywords

Aged
Angina Pectoris
Collateral Circulation
Coronary Artery Bypass
Coronary Artery Bypass, Off-Pump
Disease-Free Survival
Female
Follow-Up Studies
Humans
Intraoperative Complications
Life Tables
Male
Middle Aged
Myocardial Infarction
Postoperative Complications
Randomized Controlled Trials as Topic
Treatment Outcome

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Grobbee 04 roleofcoronarycollaterals
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Nathoe, H. M., Buskens, E., Jansen, E. W. L., Suyker, W. J. L., Stella, P. R., Lahpor, J. R., van Boven, W. J., van Dijk, D., Diephuis, J. C., Borst, C., Moons, K. G. M., Grobbee, D. E., & de Jaegere, P. P. T. (2004). Role of coronary collaterals in off-pump and on-pump coronary bypass surgery. Circulation, 110(13), 1738-1742. https://doi.org/10.1161/01.CIR.0000143105.42988.FD

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title = "Role of coronary collaterals in off-pump and on-pump coronary bypass surgery",

abstract = "BACKGROUND: Collaterals limit infarct size, preserve viability, and reduce mortality in patients with acute myocardial infarction. In patients with stable coronary disease, collaterals are associated with less angina and ischemia during angioplasty and fewer ischemic events during follow-up. The role of collaterals has not been studied in patients undergoing off-pump or on-pump bypass surgery.METHODS AND RESULTS: The population consisted of the 281 patients randomized to off-pump or on-pump CABG in the Octopus Study. Collaterals were defined on the baseline angiogram with the Rentrop score and were present in 49% and 51% of the patients in the off-pump and on-pump group, respectively. Perioperative myocardial infarction was defined by a creatine kinase-MB to CK ratio >10% and occurred in 18.2% in the off-pump group and 32.5% in the on-pump group. The unadjusted OR of perioperative myocardial infarction in the presence of collaterals was 0.31 (95% CI 0.17 to 0.84) in the off-pump group and 1.06 (95% CI 0.29 to 3.85) in the on-pump group After adjustment for age, gender, hypertension, hypercholesterolemia, diabetes, multivessel disease, ventricular dysfunction, incomplete revascularization, and ischemic time, the OR was 0.34 (95% CI 0.14 to 0.84) in the off-pump group and 1.28 (95% CI 0.30 to 5.40) in the on-pump group, respectively. Kaplan-Meier estimates of event-free survival at 1 year were 87% in patients with and 69% in those without collaterals after off-pump CABG. These estimates were 66% and 63%, respectively, after on-pump CABG.CONCLUSIONS: Collaterals protect against perioperative myocardial infarction during off-pump surgery but not during on-pump surgery and are associated with a better 1-year event-free survival.",

keywords = "Aged, Angina Pectoris, Collateral Circulation, Coronary Artery Bypass, Coronary Artery Bypass, Off-Pump, Disease-Free Survival, Female, Follow-Up Studies, Humans, Intraoperative Complications, Life Tables, Male, Middle Aged, Myocardial Infarction, Postoperative Complications, Randomized Controlled Trials as Topic, Treatment Outcome",

author = "H.M. Nathoe and Erik Buskens and E.W.L. Jansen and W.J.L. Suyker and P.R. Stella and J.R. Lahpor and {van Boven}, W.J. and {van Dijk}, D. and J.C. Diephuis and C. Borst and K.G.M. Moons and D.E. Grobbee and {de Jaegere}, P.P.T.",

year = "2004",

month = sep,

day = "28",

doi = "10.1161/01.CIR.0000143105.42988.FD",

language = "English",

volume = "110",

pages = "1738--1742",

journal = "Circulation",

issn = "0009-7322",

publisher = "Lippincott Williams & Wilkins",

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TY - JOUR

T1 - Role of coronary collaterals in off-pump and on-pump coronary bypass surgery

AU - Nathoe, H.M.

AU - Buskens, Erik

AU - Jansen, E.W.L.

AU - Suyker, W.J.L.

AU - Stella, P.R.

AU - Lahpor, J.R.

AU - van Boven, W.J.

AU - van Dijk, D.

AU - Diephuis, J.C.

AU - Borst, C.

AU - Moons, K.G.M.

AU - Grobbee, D.E.

AU - de Jaegere, P.P.T.

PY - 2004/9/28

Y1 - 2004/9/28

N2 - BACKGROUND: Collaterals limit infarct size, preserve viability, and reduce mortality in patients with acute myocardial infarction. In patients with stable coronary disease, collaterals are associated with less angina and ischemia during angioplasty and fewer ischemic events during follow-up. The role of collaterals has not been studied in patients undergoing off-pump or on-pump bypass surgery.METHODS AND RESULTS: The population consisted of the 281 patients randomized to off-pump or on-pump CABG in the Octopus Study. Collaterals were defined on the baseline angiogram with the Rentrop score and were present in 49% and 51% of the patients in the off-pump and on-pump group, respectively. Perioperative myocardial infarction was defined by a creatine kinase-MB to CK ratio >10% and occurred in 18.2% in the off-pump group and 32.5% in the on-pump group. The unadjusted OR of perioperative myocardial infarction in the presence of collaterals was 0.31 (95% CI 0.17 to 0.84) in the off-pump group and 1.06 (95% CI 0.29 to 3.85) in the on-pump group After adjustment for age, gender, hypertension, hypercholesterolemia, diabetes, multivessel disease, ventricular dysfunction, incomplete revascularization, and ischemic time, the OR was 0.34 (95% CI 0.14 to 0.84) in the off-pump group and 1.28 (95% CI 0.30 to 5.40) in the on-pump group, respectively. Kaplan-Meier estimates of event-free survival at 1 year were 87% in patients with and 69% in those without collaterals after off-pump CABG. These estimates were 66% and 63%, respectively, after on-pump CABG.CONCLUSIONS: Collaterals protect against perioperative myocardial infarction during off-pump surgery but not during on-pump surgery and are associated with a better 1-year event-free survival.

AB - BACKGROUND: Collaterals limit infarct size, preserve viability, and reduce mortality in patients with acute myocardial infarction. In patients with stable coronary disease, collaterals are associated with less angina and ischemia during angioplasty and fewer ischemic events during follow-up. The role of collaterals has not been studied in patients undergoing off-pump or on-pump bypass surgery.METHODS AND RESULTS: The population consisted of the 281 patients randomized to off-pump or on-pump CABG in the Octopus Study. Collaterals were defined on the baseline angiogram with the Rentrop score and were present in 49% and 51% of the patients in the off-pump and on-pump group, respectively. Perioperative myocardial infarction was defined by a creatine kinase-MB to CK ratio >10% and occurred in 18.2% in the off-pump group and 32.5% in the on-pump group. The unadjusted OR of perioperative myocardial infarction in the presence of collaterals was 0.31 (95% CI 0.17 to 0.84) in the off-pump group and 1.06 (95% CI 0.29 to 3.85) in the on-pump group After adjustment for age, gender, hypertension, hypercholesterolemia, diabetes, multivessel disease, ventricular dysfunction, incomplete revascularization, and ischemic time, the OR was 0.34 (95% CI 0.14 to 0.84) in the off-pump group and 1.28 (95% CI 0.30 to 5.40) in the on-pump group, respectively. Kaplan-Meier estimates of event-free survival at 1 year were 87% in patients with and 69% in those without collaterals after off-pump CABG. These estimates were 66% and 63%, respectively, after on-pump CABG.CONCLUSIONS: Collaterals protect against perioperative myocardial infarction during off-pump surgery but not during on-pump surgery and are associated with a better 1-year event-free survival.

KW - Aged

KW - Angina Pectoris

KW - Collateral Circulation

KW - Coronary Artery Bypass

KW - Coronary Artery Bypass, Off-Pump

KW - Disease-Free Survival

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Intraoperative Complications

KW - Life Tables

KW - Male

KW - Middle Aged

KW - Myocardial Infarction

KW - Postoperative Complications

KW - Randomized Controlled Trials as Topic

KW - Treatment Outcome

U2 - 10.1161/01.CIR.0000143105.42988.FD

DO - 10.1161/01.CIR.0000143105.42988.FD

M3 - Article

C2 - 15381650

SN - 0009-7322

VL - 110

SP - 1738

EP - 1742

JO - Circulation

JF - Circulation

IS - 13

ER -

Role of coronary collaterals in off-pump and on-pump coronary bypass surgery

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Keywords

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