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Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
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Does off-pump or minimally invasive coronary artery bypass reduce mortality, morbidity, and resource utilization when

Daniel Bainbridge1, Davy Cheng, Janet Martin

  • 1Department of Anesthesia & Perioperative Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.

The Journal of Thoracic and Cardiovascular Surgery
|February 27, 2007
PubMed

Insights

Off-pump coronary artery bypass (OPCAB) offers improved clinical outcomes for single- or double-vessel coronary artery disease compared to percutaneous coronary intervention (PCI). However, OPCAB is associated with a longer hospital stay.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Medical Technology Assessment

Background:

  • Coronary artery disease (CAD) management involves surgical and interventional approaches.
  • Off-pump coronary artery bypass (OPCAB) and percutaneous coronary intervention (PCI) are common revascularization strategies.
  • Comparative effectiveness of OPCAB versus PCI for specific CAD severities requires ongoing evaluation.

Purpose of the Study:

  • To meta-analyze randomized trials comparing OPCAB (including minimally invasive) with PCI for single- or double-vessel CAD.
  • To assess the impact of OPCAB versus PCI on short-term and midterm clinical outcomes and resource utilization.

Main Methods:

  • Systematic search of randomized trials up to May 2006 in MEDLINE, Cochrane Library, EMBASE, and abstract databases.
  • Inclusion criteria: randomized trials comparing OPCAB (sternotomy or minimally invasive) vs. PCI with predefined outcomes.
  • Statistical analysis using odds ratios (OR) and weighted mean differences (WMD) with 95% confidence intervals (CI).

Main Results:

  • Six trials with 989 patients were analyzed.
  • OPCAB significantly reduced angina recurrence (OR 0.54) and need for reintervention (OR 0.24) at 1-5 years compared to PCI.
  • Major adverse coronary events were reduced (OR 0.44) and event-free survival increased (OR 2.32) with OPCAB; coronary stenosis was also reduced (OR 0.31).
  • Hospital stay was significantly longer with OPCAB (WMD 4.03 days); quality of life favored OPCAB in some aspects.
  • No significant differences in death, myocardial infarction, or stroke between groups.

Conclusions:

  • OPCAB demonstrates superior short-term and midterm clinical outcomes compared to PCI in patients with single- or double-vessel CAD.
  • The benefits of OPCAB include reduced reintervention rates and major adverse coronary events.
  • A notable drawback of OPCAB is the associated increase in hospital length of stay.
Abstract

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