Most Read Articles
12 Aug 2019
Treatment with nebivolol yields more favourable changes in 24-hour, intradialytic and daytime systolic and diastolic blood pressure variability in patients with intradialytic hypertension, a study has found.
Stephen Padilla, 25 Jul 2019
Nonvitamin K antagonist oral anticoagulants (NOACs) appear to confer more clinical benefits to elderly patients with atrial fibrillation (AF) than vitamin K antagonist anticoagulants (VKAs), suggests a study, adding that this is primarily driven by the lower rates of major bleeding.
11 Aug 2019
Intraoperative methylprednisolone does not appear to significantly prevent the incidence of death, cardiac arrest and other injuries in neonates undergoing cardiac surgery with cardiopulmonary bypass, according to a recent study.
25 Jul 2019
Adding a third drug to achieve the target blood pressure (BP) seems to be more effective than increasing the dose of existing dual therapy without any increase in adverse events, suggest the results of a meta-analysis, adding that early use of triple therapy can help improve hypertension control.

Off-pump CABG tied to higher mortality in patients with left main disease

13 Aug 2019

Off-pump, compared with on-pump, coronary artery bypass grafting (CABG) in patients with left main disease results in a lower rate of revascularization of the coronary arteries supplying the inferolateral wall and an increased risk of 3-year all-cause death, results of the EXCEL* trial have shown.

Of the 923 CABG patients, 652 underwent on-pump surgery and 271 off-pump. The extent of disease was similar between the two groups, but patients in the off-pump arm had a lower rate of revascularization of the left circumflex coronary artery (84.1 percent vs 90.0 percent; p=0.01) and right coronary artery (31.1 percent vs 40.6 percent; p=0.007).

After inverse probability of treatment weighting (IPTW) adjustment for baseline difference, an association was found between off-pump surgery and a significant increase in the risk of 3-year all-cause death (8.8 percent vs 4.5 percent; hazard ratio [HR], 1.94, 95 percent CI, 1.10–3.41; p=0.02), as well as a nonsignificant difference in the risk for the composite endpoint of death, myocardial infarction or stroke (11.8 percent vs 9.2 percent; HR, 1.28, 0.82–2.00; p=0.28).

The EXCEL trial compared percutaneous coronary intervention with everolimus-eluting stents with CABP in patients with left main disease. CABG was performed with or without cardiopulmonary bypass (on-pump vs off-pump surgery) according to the discretion of the operator. IPTW for treatment effect estimation was used to compare the 3-year outcomes in the off-pump and on-pump groups.

“Concerns remain for a greater risk of incomplete revascularization and reduced survival with off-pump CABG surgery compared with on-pump surgery particularly in patients with left main disease and extensive underlying myocardial ischaemia,” the authors said.

*Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization

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Most Read Articles
12 Aug 2019
Treatment with nebivolol yields more favourable changes in 24-hour, intradialytic and daytime systolic and diastolic blood pressure variability in patients with intradialytic hypertension, a study has found.
Stephen Padilla, 25 Jul 2019
Nonvitamin K antagonist oral anticoagulants (NOACs) appear to confer more clinical benefits to elderly patients with atrial fibrillation (AF) than vitamin K antagonist anticoagulants (VKAs), suggests a study, adding that this is primarily driven by the lower rates of major bleeding.
11 Aug 2019
Intraoperative methylprednisolone does not appear to significantly prevent the incidence of death, cardiac arrest and other injuries in neonates undergoing cardiac surgery with cardiopulmonary bypass, according to a recent study.
25 Jul 2019
Adding a third drug to achieve the target blood pressure (BP) seems to be more effective than increasing the dose of existing dual therapy without any increase in adverse events, suggest the results of a meta-analysis, adding that early use of triple therapy can help improve hypertension control.