Comparison of outcomes between off-pump and on-pump coronary artery bypass graft surgery using collaborative targeted maximum likelihood estimation

• Published in: Scientific reports Vol. 14; no. 1; p. 11373
• Main Authors: Adineh, Hossein Ali, Hoseini, Kaveh, Zareban, Iraj, Jalali, Arash, Nazemipour, Maryam, Mansournia, Mohammad Ali
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 18.05.2024; Nature Publishing Group; Nature Portfolio
• Subjects: 692/308; 692/4019; 692/499; Aged; Bypass; C-TMLE; Cardiopulmonary Bypass - adverse effects; Collaboration; Coronary artery; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - mortality; Coronary Artery Bypass, Off-Pump - adverse effects; Coronary Artery Bypass, Off-Pump - mortality; Coronary Artery Disease - mortality; Coronary Artery Disease - surgery; Coronary vessels; Diabetes; Diabetes mellitus; Female; Health risks; Heart surgery; Humanities and Social Sciences; Humans; Iran - epidemiology; Likelihood Functions; Male; Middle Aged; Mortality; Mortality risk; multidisciplinary; Off-pump; Propensity Score; Risk ratio; Science; Science (multidisciplinary); Surgery; Surgical operations; TMLE; Treatment Outcome; Iran; C-TMLE; Off-pump; Risk ratio; TMLE
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-024-61846-1

There are some discrepancies about the superiority of the off-pump coronary artery bypass grafting (CABG) surgery over the conventional cardiopulmonary bypass (on-pump). The aim of this study was estimating risk ratio of mortality in the off-pump coronary bypass compared with the on-pump using a causal model known as collaborative targeted maximum likelihood estimation (C-TMLE). The data of the Tehran Heart Cohort study from 2007 to 2020 was used. A collaborative targeted maximum likelihood estimation and targeted maximum likelihood estimation, and propensity score (PS) adjustment methods were used to estimate causal risk ratio adjusting for the minimum sufficient set of confounders, and the results were compared. Among 24,883 participants (73.6% male), 5566 patients died during an average of 8.2 years of follow-up. The risk ratio estimates (95% confidence intervals) by unadjusted log-binomial regression model, PS adjustment, TMLE, and C-TMLE methods were 0.86 (0.78–0.95), 0.88 (0.80–0.97), 0.88 (0.80–0.97), and 0.87(0.85–0.89), respectively. This study provides evidence for a protective effect of off-pump surgery on mortality risk for up to 8 years in diabetic and non-diabetic patients.