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Off-Pump vs. On-Pump CABG: 5-Year Data
Cardiovascular outcomes were similar at 5 years, and the rate of cognitive decline was 50% with each type of surgery.
Cognitive decline has been reported in many patients who undergo coronary artery bypass grafting (CABG). In the Octopus Study, a randomized comparison of off-pump and on-pump CABG in 281 low-risk patients (mean age, 61; 68% men), the two groups did not differ significantly in their rates of mortality, stroke, or cognitive decline at 3 months or at 1 year (Journal Watch Cardiology Apr 26 2002). Now, we have data from the 260 subjects who survived to the 5-year evaluation.
At 5 years, 50% of each group exhibited cognitive decline, defined as a 
20% decrease in performance on at least 3 of 11 neuropsychological test variables. Only older age and lower level of education were associated with cognitive decline in a multivariable analysis. The 5-year incidence of cardiovascular events was similar in the off-pump and on-pump groups (21% and 18%, respectively). Quality of life also was similar between the groups, except that the on-pump group had slightly fewer role limitations because of physical health.
Comment: This study failed to detect either a cardiovascular or a cognitive advantage of off-pump CABG over on-pump CABG at 5 years. The 5-year rate of cognitive decline in this carefully studied, low-risk trial population was high — 50%. Informed consent for CABG should incorporate information about cognitive risk.
— Harlan M. Krumholz, MD, SM
Published in Journal Watch Cardiology February 20, 2007
Citation(s):
van Dijk D et al. for the Octopus Study Group. Cognitive and cardiac outcomes 5 years after off-pump vs on-pump coronary artery bypass graft surgery. JAMA 2007 Feb 21; 297:701-8.
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