Randomized comparison between stenting and off-pump bypass surgery in patients referred for angioplasty.
BACKGROUND
Stenting improves cardiac outcome in comparison with balloon angioplasty. Compared with conventional surgery, off-pump bypass surgery on the beating heart without cardiopulmonary bypass may reduce morbidity, hospital stay, and costs. The purpose, therefore, was to compare cardiac outcome, quality of life, and cost-effectiveness 1 year after stenting and after off-pump surgery.


RESULTS
Patients referred for angioplasty (n=280) were randomly assigned to stenting (n=138) or off-pump bypass surgery. At 1 year, survival free from stroke, myocardial infarction, and repeat revascularization was 85.5% after stenting and 91.5% after off-pump surgery (relative risk, 0.93; 95% CI, 0.86 to 1.02). Freedom from angina was 78.3% after stenting and 87.0% after off-pump surgery (P=0.06). Quality-adjusted lifetime was 0.82 year after stenting and 0.79 year after off-pump surgery (P=0.09). Hospital stay after the initial procedure was 1.43 and 5.77 days, respectively (P<0.01). Stenting reduced overall costs by 2933 dollars (26.2%) per patient (8276 dollars versus 11 209 dollars; P<0.01). Stenting was more cost-effective in 95% of the bootstrap estimates.


CONCLUSIONS
At 1 year, stenting was more cost-effective than off-pump surgery while maintaining comparable cardiac outcome and quality of life. Stenting rather than off-pump surgery, therefore, can be recommended as a first-choice revascularization strategy in selected patients.
Eefting
Frank
F
Department of Cardiology, Heart Lung Center Utrecht, Utrecht, The Netherlands.
Nathoe
Hendrik
H
van Dijk
Diederik
D
Jansen
Erik
E
Lahpor
Jaap
J
Stella
Pieter
P
Suyker
Willem
W
Diephuis
Jan
J
Suryapranata
Harry
H
Ernst
Sjef
S
Borst
Cornelius
C
Buskens
Erik
E
Grobbee
Diederick
D
de Jaegere
Peter
P
D000368:Aged; D000787:Angina Pectoris / Q000601:surgery* / Q000628:therapy; D000800:Angioplasty, Balloon; D001026:Coronary Artery Bypass / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009426:Netherlands; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D015607:Stents / Q000191:economics; D020521:Stroke / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome