Is off-pump coronary artery bypass grafting superior to drug-eluting stents for the treatment of coronary artery disease? A meta-analysis of randomized and nonrandomized studies

• Published in: International journal of cardiology 2014-07, Vol.174 (3), p.640-653
• Main Authors: Lu, Di, Nie, Ximing, Wan, Jun, He, Shengping, Du, Songlin, Zhang, Zhen, Wang, Zhenkang, Wang, Wujun
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Coronary Artery Bypass, Off-Pump - methods; Coronary artery disease; Coronary Artery Disease - diagnosis; Coronary Artery Disease - epidemiology; Coronary Artery Disease - surgery; Coronary heart disease; Drug-eluting stent; Drug-Eluting Stents; Heart; Humans; Medical sciences; Meta-analysis; Observational cohort; Off-pump coronary artery bypass grafting; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Randomized controlled trial; Randomized Controlled Trials as Topic - methods; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2014.04.182

Abstract Background As drug-eluting stent (DES) has almost overcome the disadvantage of frequent restenosis, off-pump coronary artery bypass grafting (OPCAB) has been introduced to avoid complications of cardiopulmonary bypass. However, which approach may promise better outcomes for patients with coronary artery disease remains controversial. Methods Three databases were searched. The outcomes of interest were major adverse cardiac and cerebrovascular events (MACCE), all-cause death, target vessel revascularization (TVR), repeat revascularization (RRV), myocardial infarction (MI), and cerebrovascular events (CVE). The relative risk (RR) was calculated as the summary statistic. Results 11,452 patients from 22 studies were included, of which 4949 patients underwent OPCAB and 6503 patients received DES. The cumulative rates of MACCE (RR [95% CI] = 0.43 [0.34, 0.54], P < 0.00001), all-cause death (RR [95% CI] = 0.56 [0.33, 0.96], P = 0.03), TVR (RR [95% CI] = 0.33 [0.21, 0.53], P < 0.00001), RRV (RR [95% CI] = 0.22 [0.11, 0.42], P < 0.00001) and MI (RR [95% CI] = 0.13 [0.05, 0.29], P < 0.00001) at 3 years were all lower in OPCAB group. The incidences of in-hospital death (RR [95% CI] = 1.31 [0.81, 2.13], P = 0.27) and MI (RR [95% CI] = 1.03 [0.60, 1.78], P = 0.92) were not different between groups, but the rate of in-hospital CVE was lower (RR [95% CI] = 2.6355 [1.0033, 6.9228], P = 0.05) in DES group. Conclusions OPCAB presents better long-term outcomes of MACCE, all-cause mortality, TVR, RRV and MI but uncertain outcome of postoperative CVE without influencing the incidences of in-hospital death and MI.