The Journal of Thoracic and Cardiovascular Surgery
Volume 133, Issue 3 , Pages 623-631, March 2007

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

Presented at the Health Technology Assessment International (HTAi) Conference in Rome, June 20–22, 2005.

  • Daniel Bainbridge, MD, FRCPC

      Affiliations

    • Department of Anesthesia & Perioperative Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
    • Assistant Professor.
    • ,
  • Davy Cheng, MD, MSc, FRCPC

      Affiliations

    • Department of Anesthesia & Perioperative Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
    • Professor and Chair, Department of Anesthesia.
    • Corresponding Author InformationAddress for reprints: D. Cheng, MD, MSc, FRCPC, Department of Anesthesia & Perioperative Medicine, London Health Sciences Centre—University Hospital, 339 Windermere Rd, Room 3-CA19, London, Ontario, Canada N6A 5A5.
    • ,
  • Janet Martin, PharmD

      Affiliations

    • Department of Pharmacy, Physiology & Pharmacology, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
    • Director, High Impact Technology Evaluation Centre (HiTEC).
    • ,
  • Richard Novick, MD, MSc, FRCSC

      Affiliations

    • Division of Cardiac Surgery, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
    • Professor and Head, Division of Cardiac Surgery.
    • ,
  • The Evidence-based Peri-operative Clinical Outcomes Research (EPiCOR) Group

Received 11 September 2006; received in revised form 25 October 2006; accepted 1 November 2006.

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.

CTSNet classification: 23, 25, 28

Abbreviations and Acronyms: CABG, coronary artery bypass grafting, CCAB, conventional coronary artery bypass, CROQ, Coronary Revascularization and Outcome Questionnaire, EQ-5D, EuroQOL, LOS, length of stay, MACE, major adverse coronary events, MIDCAB, minimally invasive off-pump coronary artery bypass, OPCAB, off-pump coronary artery bypass, OR, odds ratio, PCI, percutaneous coronary intervention, SAQ, Seattle Angina Questionnaire, SF-36, short-form health survey, WMD, weighted mean differences

 

 Funding: Department of Anesthesia and Perioperative Medicine, University of Western Ontario and from an HTA Capacity Building Grant awarded by the Canadian Coordinating Office of Health Technology Assessment (CCOHTA). No funds were received from proprietary sources.Ethics approval was not required for the conduct of this study.

PII: S0022-5223(06)02119-2

doi:10.1016/j.jtcvs.2006.11.019

The Journal of Thoracic and Cardiovascular Surgery
Volume 133, Issue 3 , Pages 623-631, March 2007

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