title: Stent versus off-pump coronary bypass grafting in the second-generation drug-eluting stent era.
abstract: BACKGROUND
  Second-generation drug-eluting stents (DESs) are known to have better safety and clinical outcomes compared with the first-generation DESs. We compared the clinical results of off-pump coronary artery bypass grafting (OPCAB) with percutaneous coronary intervention (PCI) using second-generation DESs.
  
  
  METHODS
  The study enrolled 1,821 patients with triple-vessel or left main coronary disease, or both, who underwent OPCAB or PCI with second-generation DESs from 2008 to 2011. Major adverse cardiac and cerebrovascular events (MACCEs), including death, myocardial infarction, stroke, and target vessel revascularization, were retrospectively compared between the two groups in a real-world and in a matched population (n = 1,294). Follow-up duration was 23.0 ± 13.0 months (range, 0 to 56 months).
  
  
  RESULTS
  The postprocedural mortality rate was comparable between the two groups (p = 0.384). The overall rate of MAACEs was 7.3% in the PCI group and 3.8% in the OPCAB group (p = 0.001). The 3-year rate of freedom from MACCEs was 88.4% ± 1.5% in the PCI group and 94.9% ± 1.0% in the OPCAB group (p < 0.001). In a matched population comparison, the 3-year rate of freedom from a MACCE was 87.5% ± 2.0% in the PCI group and 95.3% ± 1.2% in the OPCAB group (p = 0.001). The determining factors were nonfatal myocardial infarction and target vessel revascularization. The OPCAB group showed a superior rate of freedom from MACCEs in the triple-vessel (p = 0.008) and left main subset analysis (p = 0.001).
  
  
  CONCLUSIONS
  The OPCAB showed superior outcomes in triple-vessel or left main disease, or both, compared with PCI in the second-generation DES era after 23 months of follow-up. Nonfatal myocardial infarction and target vessel revascularization were the determining factors. Longer follow-up with randomization will clarify our results.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Gijong
authors.initials: G
authors.lastname: Yi
authors.forename: Hyun-Chel
authors.initials: HC
authors.lastname: Joo
authors.forename: Young-Nam
authors.initials: YN
authors.lastname: Youn
authors.forename: Soonchang
authors.initials: S
authors.lastname: Hong
authors.forename: Kyung-Jong
authors.initials: KJ
authors.lastname: Yoo
mesh_terms: D000368:Aged; D047549:Coronary Artery Bypass, Off-Pump; D003324:Coronary Artery Disease / Q000601:surgery*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies
keywords: 23