Comparison of off-pump coronary artery bypass grafting with percutaneous coronary intervention versus drug-eluting stents for three-vessel coronary artery disease.

Abstract

BACKGROUND: Drug-eluting stents (DESs) have challenged coronary bypass grafting as the gold standard for 3-vessel coronary artery disease. This study compared the clinical results between percutaneous intervention with DESs vs off-pump coronary bypass surgery (OPCAB).

METHODS: The study included 388 matched patients with 3-vessel coronary artery diseases who were treated either with DESs or OPCAB. We compared 30-day, 12-month, and cumulative major adverse cardiac and cerebrovascular events (MACCE) during the follow-up.

RESULTS: The overall follow-up was 98.5%. Follow-up duration was 621.1 +/- 259.9 days (range, 13 to 1117 days). The rates of MAACE in the DES and OPCAB group were, respectively, 1.5% at 30 days (p = 0.315) and 9.8% and 3.6% at 12 months (p = 0.015). During follow-up, five deaths occurred in the DES group and one in OPCAB group (p = 0.1). Three-year survival rate was 95.1% +/- 2.9% in DES group and 99.5% +/- 0.5% in OPCAB group (p = 0.075). Survival free from MACCE at 3 years was 73.3% +/- 5.3% in DES group and 91.3% +/- 2.9% in OPCAB group (p < 0.001). The major event for the differences between the groups was target vessel revascularization (p < 0.001): 21 DES patients (10.8%) vs 6 OPCAB patients (3.1%).

CONCLUSIONS: OPCAB showed better clinical outcome in 12-month and cumulative MACCE rate in 3-vessel coronary artery diseases. The major factor for the difference was target vessel revascularization. Longer follow-up is needed to clarify the differences between the two groups.