Related Experiment Video
Updated: Jan 16, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Effectiveness of the various revascularization techniques in multivessel coronary artery disease: a systematic review
I Komang Adhi Parama Harta1, Putu Febry Krisna Pertiwi2, I Gde Julia Arta3
1Cardiothoracic and Vascular Surgery Division, Department of Surgery, Faculty of Medicine, Udayana University, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia.
Insights
Off-pump coronary artery bypass (OPCAB) techniques, especially anaortic OPCAB (anOPCAB), reduce early mortality and stroke risk in multivessel coronary artery disease (MVD) patients. These methods offer better revascularization than percutaneous coronary intervention (PCI).
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Evidence-Based Medicine
Background:
- Multivessel coronary artery disease (MVD) necessitates revascularization, but optimal strategies for reducing stroke and achieving complete revascularization are debated.
- Existing research lacks definitive comparisons of various revascularization techniques regarding key clinical outcomes.
Purpose of the Study:
- To systematically compare major revascularization strategies for MVD.
- To evaluate effectiveness in reducing early mortality, stroke, postoperative atrial fibrillation (POAF), and renal failure.
- To assess the rate of complete revascularization across different techniques.
Main Methods:
- A systematic review and network meta-analysis of 32 studies involving 65,861 patients.
- Comparison of five techniques: on-pump coronary artery bypass (ONCAB), off-pump coronary artery bypass (OPCAB), OPCAB with proximal anastomotic device (OPCAB-PAD), anaortic OPCAB (anOPCAB), and percutaneous coronary intervention (PCI).
- Statistical analysis using random effects models to calculate odds ratios (ORs) and 95% confidence intervals (CIs); risk of bias assessed using RoB2 and ROBINS-I tools.
Main Results:
- Anaortic OPCAB (anOPCAB), OPCAB-PAD, and OPCAB showed significantly lower early mortality compared to ONCAB.
- Stroke risk was substantially reduced with anOPCAB and OPCAB-PAD versus ONCAB.
- All surgical approaches achieved superior complete revascularization rates compared to PCI.
- anOPCAB demonstrated significantly lower rates of POAF and renal failure than ONCAB.
Conclusions:
- Off-pump techniques, particularly anOPCAB, offer significant advantages in reducing stroke risk and improving early mortality in MVD patients.
- These off-pump strategies provide comparable or superior revascularization outcomes to ONCAB.
- Percutaneous coronary intervention (PCI) is associated with incomplete revascularization, suggesting its primary role in high-surgical-risk patients.
Background:
Multivessel coronary artery disease (MVD) often requires revascularization. However, the effectiveness of various techniques in reducing stroke and achieving complete revascularization remains uncertain. This study aimed to address this gap by comparing key revascularization strategies in terms of early mortality, stroke, complete revascularization, postoperative atrial fibrillation (POAF), and renal failure.
Methods:
This study is a systematic review and network meta-analysis of 32 studies including 65,861 patients. Five revascularization techniques were compared: on-pump coronary artery bypass (ONCAB), off-pump coronary artery bypass (OPCAB), OPCAB with proximal anastomotic device (OPCAB-PAD), anaortic OPCAB (anOPCAB), and percutaneous coronary intervention (PCI). Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random effects model. Risk of bias was assessed using the RoB2 and ROBINS-I tools.
Results:
Compared to ONCAB, early mortality was significantly lower with anOPCAB (OR: 0.57, 95% CI: 0.44-0.73), OPCAB-PAD (OR: 0.61, 95% CI: 0.40-0.92), and OPCAB (OR: 0.64, 95% CI: 0.47-0.87). Stroke risk was lowest with anOPCAB (OR: 0.29, 95% CI: 0.21-0.40) and OPCAB-PAD (OR: 0.32, 95% CI: 0.21-0.49). All surgical techniques achieved significantly more complete revascularization than PCI. Both POAF and renal failure were significantly lower with anOPCAB compared to ONCAB (POAF: OR: 0.72, 95% CI: 0.59-0.89; renal failure: OR: 0.63, 95% CI: 0.46-0.86). No significant publication bias was detected for mortality and stroke, though funnel plot asymmetry was noted for revascularization.
Conclusion:
Off-pump techniques, particularly anOPCAB, significantly reduce stroke risk while achieving comparable revascularization success to ONCAB. PCI remains limited by incomplete revascularization, supporting its use primarily in patients at high surgical risk.
More Related Videos
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
04:30A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:27Peripheral Artery Disease III: Interprofessional Care
01:26Atherosclerosis III: Management
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Angina IV: Management
01:25Antianginal Drugs: Calcium Channel Blockers and Ranolazine
CCBs, a diverse class that includes dihydropyridines (nifedipine) and diphenylalkylamines (verapamil and diltiazem), exert their effect by blocking calcium channels in cardiac and smooth muscle cells. This...