Comparison of off-pump coronary artery bypass grafting with percutaneous coronary intervention versus drug-eluting stents for three-vessel coronary artery disease.
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.
Yi
Gijong
G
Department of Thoracic and Cardiovascular Surgery, Yongdong Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Youn
Young-Nam
YN
Yoo
Kyung-Jong
KJ
Hong
You-Sun
YS
D015906:Angioplasty, Balloon, Coronary; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000517:prevention & control; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000628:therapy*; D023903:Coronary Restenosis / Q000517:prevention & control; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods; D012008:Recurrence; D016019:Survival Analysis; D016896:Treatment Outcome; D014654:Vascular Patency