Off-Pump or Minimally Invasive Coronary Artery Bypass Compared with Percutaneous Coronary Intervention

A systematic review 1 including 6 studies with a total of 989 subjects was abstracted in DARE. Compared with percutaneous coronary intervention (PCI), off-pump coronary artery bypass (OPCAB) decreased angina recurrence (OR 0.54, 95% CI 0.34 to 0.87) and need for reintervention at 1 to 5 years (OR 0.24, 95% CI 0.15 to 0.40; 5 studies). Major adverse coronary events were significantly reduced (OR 0.44, 95% CI 0.30 to 0.63) and event-free survival was significantly increased at 1 to 5 years (OR 2.32, 95% CI 1.62 to 3.32) for OPCAB versus PCI. Coronary stenosis at 6 months was reduced with OPCAB compared with PCI (OR 0.31, 95% CI 0.18 to 0.55).

Hospital stay was significantly increased with OPCAB versus PCI (WMD 4.03, 95% CI 2.37 to 5.70). Two studies measured quality of life. One study reported a significant improvement in quality of life associated with PCI compared to OPCAB at 1 month, but reported no significant difference at 1 year. The other study reported statistically significant improvements associated with OPCAB among only three domains of four quality-of-life instruments. Death, myocardial infarction, and stroke did not significantly differ.

References

• Bainbridge D, Cheng D, Martin J, Novick R; Evidence-based Peri-operative Clinical Outcomes Research (EPiCOR) Group. Does off-pump or minimally invasive coronary artery bypass reduce mortality, morbidity, and resource utilization when compared with percutaneous coronary intervention? A meta-analysis of randomized trials. J Thorac Cardiovasc Surg. 2007;133(3):623-31. [DARE]