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.
OBJECTIVE
To determine, through meta-analysis, whether off-pump coronary artery bypass, including minimally invasive off-pump coronary artery bypass, improves short-term and midterm outcomes compared with percutaneous coronary intervention for single- or double-vessel coronary artery disease.


METHODS
The primary outcome was need for coronary reintervention at 1 to 5 years. Secondary outcomes included all major clinical morbidities and resource utilization. A comprehensive search was undertaken to identify all randomized trials of off-pump coronary artery bypass versus percutaneous coronary intervention. MEDLINE, Cochrane Library, EMBASE, and abstract databases were searched up to May 2006. All randomized trials comparing off-pump coronary artery bypass (sternotomy or minimally invasive) versus percutaneous coronary intervention and reporting at least one predefined outcome were included. Odds ratios (OR, 95% confidence intervals [CI]) and weighted mean differences (WMD, 95% CI) were analyzed.


RESULTS
Six trials involving 989 patients were included. Compared with percutaneous coronary intervention, off-pump coronary artery bypass decreased angina recurrence (OR 0.54, 95% CI 0.34-0.87) and need for reintervention at 1 to 5 years (OR 0.24, 95% CI 0.15-0.40). Major adverse coronary events were significantly reduced (OR 0.44, 95% CI 0.30-0.63) and event-free survival was significantly increased at 1 to 5 years (OR 2.32, 95% CI 1.62-3.32) for off-pump coronary artery bypass versus percutaneous coronary intervention. Coronary stenosis at 6 months was reduced with off-pump coronary artery bypass compared with percutaneous coronary intervention (OR 0.31, 95% CI 0.18-0.55). Hospital stay was significantly increased with off-pump coronary artery bypass versus percutaneous coronary intervention (WMD 4.03, 95% CI 2.37-5.70). Quality of life favored off-pump coronary artery bypass in some domains but was reported in few studies. Death, myocardial infarction, and stroke did not significantly differ.


CONCLUSIONS
In single- or double-vessel disease, off-pump coronary artery bypass improved short-term and midterm clinical outcomes compared with percutaneous coronary intervention but was associated with an increased length of hospital stay.
Bainbridge
Daniel
D
Department of Anesthesia & Perioperative Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
Cheng
Davy
D
Martin
Janet
J
Novick
Richard
R
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000401:mortality*; D002423:Cause of Death; D016001:Confidence Intervals; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods / Q000401:mortality*; D023921:Coronary Stenosis / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D011336:Probability; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome