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Evidence summaries

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

In single- or double-vessel disease, off-pump coronary artery bypass (OPCAB) reduces the need for re-intervention for ischaemia, the recurrence of angina and major coronary adverse events at 1 to 5 years compared with percutaneous coronary intervention (PCI) but is associated with an increased length of hospital stay. There appears not to be differences between OPCAB and PCI in death, myocardial infarction, and stroke. Level of evidence: "A"

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]

Primary/Secondary Keywords