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André Lamy Population Health Research Institute Hamilton Health Sciences McMaster University

CORONARY: The C oronary Artery Bypass Grafting Surgery O ff o r On Pump Revascul ar ization Stud y Results at 1 Year. André Lamy Population Health Research Institute Hamilton Health Sciences McMaster University Hamilton, CANADA on behalf of the CORONARY Investigators

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André Lamy Population Health Research Institute Hamilton Health Sciences McMaster University

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  1. CORONARY: The Coronary Artery Bypass Grafting Surgery Off orOn Pump Revascularization StudyResults at 1 Year André Lamy Population Health Research Institute Hamilton Health Sciences McMaster University Hamilton, CANADA on behalf of the CORONARY Investigators Disclosures: CORONARY was funded by a grant from the Canadian Institutes of Health Research (CIHR).

  2. Background • Benefits and risks of performing CABG surgery on beating heart (off pump) not clearly established. • Meta-analyses of 59 trials involving 8961 pts • No differences in major CV outcomes except strokes • ROOBY (1 Year) • Primary Outcome: Off-pump is worse (p=0.04) • CV Deaths: Off-pump is worse (p=0.03)

  3. CORONARY Trial Organization • 79 centers in 19 countries • 4,752 patients recruited between (November 2006 October 2011) • Designed, coordinated, managed and data analysed and reported by the Population Health Research Institute, Hamilton Health Sciences and McMaster University in Hamilton, Canada • The data was monitored by independent DSMB • Funded by Canadian Institutes of Health Research

  4. Inclusion/Exclusion Criteria • Inclusion Criteria • Isolated CABG with median sternotomy • One of the following: • Peripheral vascular disease • Cerebrovascular disease • Renal Insufficiency • Age ≥ 70 years • Age 60 -69 with at least one risk factor (diabetes, urgent revascularization, smoker, LVEF ≤ 35%) • Age 55 -59 with at least twoof the above risk factors • Exclusions • Additional cardiac procedure planned • Contraindications to off-pump or on-pump CABG • Emergency or re-do CABG

  5. Qualifications of Surgeons • Surgical expertise-based randomization • > 2 years of experience as staff cardiac surgeon and • > 100 cases of one or both techniques • Trainees were not allowed to be primary operators

  6. Primary Outcomes • 1st Co-Primary Outcome Composite of total mortality, stroke, non fatal myocardial infarction, new renal failure at 30 dayspost randomization results presented ACC 2012 results at 1 year • 2ndCo-Primary Outcome Composite of above outcomes plus repeatcoronary revascularization over 5 yrs of follow-up (expected 2016)

  7. Baseline Characteristics

  8. Baseline Disease – Pre-op Angiogram

  9. 1st Co-Primary Outcome (1 Year)

  10. Death/MI/Stroke/New Renal Failureat 1 Year HR 0.9195% CI 0.77-1.07 p value 0.24

  11. Other Outcomes at 1 year

  12. Primary Outcome between 31 days and 1 Year

  13. Other Outcomes between 31 days and 1 Year

  14. Quality of Life

  15. Neurocognitive Function

  16. Subgroups (1)

  17. Subgroups (2)

  18. Conclusions • At 1 Year there was no difference between Off pump CABG and On pump CABG: • Primary Outcome • Individual components of the Primary Outcome • Revascularization procedures • Quality of Life • Neurocognitive functions

  19. Implications • In experienced hands, both procedures are reasonable options based on mid-term results

  20. Steering Committees

  21. Final Recruitment by Country4752 patients from 79 sites in 19 countries Netherlands (27) Sweden (56) United Kingdom (227) France (4) Italy (48) Canada (830) Czech Republic (298) Estonia (91) Turkey (132) Ukraine (11) USA (68) China (781) India (1307) Colombia (57) Brazil (358) Australia (29) Uruguay (34) Chile (137) Argentina (257)

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