Randomized Comparison Between Stenting and Off-Pump Bypass Surgery in Patients Referred for Angioplasty

Abstract

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. Methods and Results-Patients referred for angioplasty (nϭ280) were randomly assigned to stenting (nϭ138) 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 (Pϭ0.06). Quality-adjusted lifetime was 0.82 year after stenting and 0.79 year after off-pump surgery (Pϭ0.09). Hospital stay after the initial procedure was 1.43 and 5.77 days, respectively (PϽ0.01). Stenting reduced overall costs by $2933 (26.2%) per patient ($8276 versus $11 209; PϽ0.01). 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.

Reduced risk of myocardial infarct and revascularization following coronary artery bypass grafting compared with percutaneous coronary intervention in patients with chronic kidney disease

“…After title and abstract review, 75 citations were examined in detail; however, 48 were excluded because they failed to meet the specified inclusion criteria. A total of 27 eligible trials were identified for inclusion, but 17 had to be excluded for the following reasons: data no longer available (n=3) 17-19 ; insufficient data to calculate eGFR (n=7) 20-26 unable to contact the investigators despite multiple attempts (n=3) 27-29 ; investigators unable (n=2) 30, 31 or unwilling (n=2) 32, 33 to share data.…”

Cerebrovascular Events After No‐Touch Off‐Pump Coronary Artery Bypass Grafting, Conventional Side‐Clamp Off‐Pump Coronary Artery Bypass, and Proximal Anastomotic Devices: A Meta‐Analysis

“…The discussion about potential shortcomings of CABG as compared to PCI was fueled after the first large industry‐funded trial3 found significantly higher rates of major adverse cardiac and cerebrovascular events in the PCI group (17.8% versus 12.4% for CABG; P =0.002), in large part because of an increased rate of repeat revascularization (13.5% versus 5.9%); however, at 12 months, strokes were 4‐fold more likely to occur with CABG (2.2% versus 0.6% with PCI; P =0.003). None of the following studies comparing PCI with OPCAB38, 39, 40, 41 were powered for stroke, and none reports the extent of “no‐touch” technique in the CABG group. Conversely, one recent trial assessing midterm outcomes of 438 patients randomly assigned to the PCI with everolimus eluting stents and 442 randomly assigned to the CABG group42 found no difference in the risk of stroke between the 2 groups: hazard ratio 0.86 (0.39–1.93); P =0.72.…”

The results of staged endovascular revascularization with use of stents with third generations of drug-eluting and biodegradable polymer in patients with acute coronary syndrome and multivessel coronary artery disease

“…Полученные результаты в целом согласуются с ранее проведенными исследованиями, сравнивающими АКШ и ЧКВ у больных ишемической болезнью сердца [16][17][18][19]. Особенностью оказания хирургической реваскуляризации методом АКШ у больных ОКС с многососудистым поражением является необходимость проведения агрессивной интенсивной терапии для компенсации недостаточности кровообращения и стабилизации нестабильной стенокардии: игнорирование вышеназванных действий ухудшает результаты операций АКШ [19].…”