Randomized comparison between stenting and off-pump bypass surgery in patients referred for angioplasty

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Health Economics

Background:

• Coronary artery stenting improves cardiac outcomes compared to balloon angioplasty.
• Off-pump bypass surgery may reduce morbidity and costs versus conventional surgery.
• Comparative data on stenting and off-pump surgery is crucial for treatment decisions.

Purpose of the Study:

• To compare cardiac outcomes, quality of life, and cost-effectiveness of stenting versus off-pump surgery at 1 year.
• To evaluate long-term clinical and economic benefits of revascularization strategies.
• To inform clinical recommendations for coronary artery disease treatment.

Main Methods:

• 280 patients undergoing angioplasty were randomized to stenting (n=138) or off-pump bypass surgery (n=142).
• Outcomes assessed at 1 year included survival, freedom from angina, quality-adjusted life years, hospital stay, and costs.
• Statistical analysis included relative risk, confidence intervals, and bootstrap estimates for cost-effectiveness.

Main Results:

• Survival free from major adverse cardiac events was comparable: 85.5% for stenting vs. 91.5% for off-pump surgery.
• Freedom from angina was higher after off-pump surgery (87.0%) vs. stenting (78.3%), though not statistically significant (P=0.06).
• Stenting significantly reduced hospital stay (1.43 vs. 5.77 days) and overall costs ($8276 vs. $11,209), proving more cost-effective.

Conclusions:

• Stenting is more cost-effective than off-pump surgery at 1 year with comparable cardiac outcomes and quality of life.
• Stenting offers a favorable economic profile and reduced resource utilization.
• Stenting is recommended as a preferred revascularization strategy for selected patients.