Predictors of mid-term symptom recurrence, adverse cardiac events and mortality in 591 unselected off-pump coronary artery bypass graft patients

Background: Off-pump coronary artery bypass (OPCAB) grafting is gaining popularity; however, decreased mid-term graft patency and increased coronary reintervention rates are reported. Study Design: Five hundred and ninty-one consecutive unselected patients underwent OPCAB grafting from February 2000 to April 2004 (mean follow-up 38.54 +/- 0.54 months). One hundred and thirteen patients had <= 2 grafts, and four hundred and seventy-eight had >= 3 grafts. At least one radial artery graft was present in 398 patients, 328 received postoperative Clopidogrel, and 391 received postoperative statins. History of at least one percutaneous coronary intervention (PCI) was present in 192 patients. Results: Twenty-nine patients developed recurrent angina, nine had myocardial infraction, and twenty underwent coronary reintervention. Five patients died of sudden cardiac death. Overall mortality was 4.9% during follow-up (29 patients). Postoperative Clopidogrel and statins as well as intraoperative shunt use significantly decreased symptom recurrence and adverse cardiac events. Diabetes, chronic obstructive pulmonary disease, prior history of PCI, and utilization of radial artery grafts were positive predictors of symptom recurrence and adverse cardiac events. Utilization of radial artery grafts, history of PCI as well as low preoperative ejection fraction increased mortality. Number of bypass grafts, type of conduit, grafted territory, hyperlipidemia, or prior coronary artery bypass graft surgery (CABG) did not influence symptom recurrence, adverse cardiac events or mortality. Conclusions: OPCAB grafting can be performed with low symptom recurrence, adverse cardiac events, and mortality rates. Modification of intra- and postoperative management strategies may improve outcomes.