ABSTRACT
Aunque los ensayos clínicos aleatorizados han comparado los resultados de la cirugía de revascularización coronaria (CRM) con y sin circulación extracorpórea (CEC), el efecto a largo plazo con la utilización de estas técnicas no ha sido evaluado. El objetivo del estudio fue evaluar la supervivencia alejada con la utilización de CRM con y sin CEC. Se incluyeron todos los pacientes sometidos a CRM durante el período 1996-2015 (n = 4687). La supervivencia a largo plazo y la incidencia de eventos cardíacos se compararon entre los que recibieron CRM sin-CEC (n = 3402) frente a los pacientes con-CEC (n = 1285). El punto final primario se definió como muerte por cualquier causa, analizándose la supervivencia a 10 años. Para reducir posibles sesgos se realizó un análisis ajustado por riesgo. La mortalidad hospitalaria global fue 3.1%, observándose una diferencia entre ambos grupos (2.3% vs. 5.2%, p < 0.0001) a favor de la cirugía sin-CEC. El análisis de la mortalidad no ajustada a largo plazo no mostró una diferencia significativa a 10 años (sin-CEC vs. con-CEC: 77.9% ± 1.2% vs. 80.2% ± 1.3%, p log rank = 0.361). En el análisis ajustado por riesgo tampoco se observó una diferencia significativa de supervivencia a 10 años (84.2% ± 2.9% vs. 80.3% ± 2.4%, p = 0.169). En conclusión, la CRM sin-CEC presentó una menor mortalidad hospitalaria, y no se encontró una diferencia en la mortalidad a largo plazo en comparación con CRM con-CEC.
Although randomized clinical trials have compared the short-term results of coronary revascularization with on-pump vs. off-pump, the long-term survival effect of off-pump coronary surgery has not been analyzed. The aim of this study was to compare the long-term survival of patients with coronary surgery with off-pump technique. All patients that underwent coronary revascularization from November 1996 to March 2015 were included (n = 4687). We analyzed the long-term survival and the incidence of cardiac events between patients who received off-pump coronary revascularization (n = 3402) against those revascularized with on-pump technique (n = 1285). The primary endpoint was defined as death from any cause. To reduce potential biases, risk-adjusted analysis was performed (propensity score). In-hospital mortality and during follow-up (10 years) for both groups were analyzed. The overall hospital mortality was 3.1%. A statistically significant difference between groups in favor of off-pump surgery was observed (2.3% vs. 5.2%, p < 0.0001). In the survival analysis, off-pump surgery proved to have similar long-term survival as on-pump surgery (off-pump vs. on-pump: 77.9% ± 1.2% vs. 80.2% ± 1.3%, p log rank = 0.361); even in the adjusted survival analysis (84.2% ± 2.9% vs. 80.3% ± 2.4%, p = 0.169). In conclusion, off-pump coronary surgery was associated with lower in-hospital mortality; and it was not associated with increased long-term survival compared with on-pump surgery.