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Original Articles: Adult Cardiac

Comparison of Off-pump Coronary Artery Bypass Grafting With Percutaneous Coronary Intervention Versus Drug-Eluting Stents for Three-Vessel Coronary Artery Disease

^a Department of Thoracic and Cardiovascular Surgery, Yongdong Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
^b Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea

Accepted for publication July 7, 2008.

^_* Address correspondence to Dr Hong, 146-92 Yongdong Severance Hospital, Dogok-dong, Kangnam-Gu, Seoul, 135-720, Korea (Email: yshongjin{at}ajou.ac.kr).

Background: Drug-eluting stents (DESs) have challenged coronary bypass grafting as the gold standard for 3-vessel coronary artery disease. This study compared the clinical results between percutaneous intervention with DESs vs off-pump coronary bypass surgery (OPCAB).

Methods: The study included 388 matched patients with 3-vessel coronary artery diseases who were treated either with DESs or OPCAB. We compared 30-day, 12-month, and cumulative major adverse cardiac and cerebrovascular events (MACCE) during the follow-up.

Results: The overall follow-up was 98.5%. Follow-up duration was 621.1 ± 259.9 days (range, 13 to 1117 days). The rates of MAACE in the DES and OPCAB group were, respectively, 1.5% at 30 days (p = 0.315) and 9.8% and 3.6% at 12 months (p = 0.015). During follow-up, five deaths occurred in the DES group and one in OPCAB group (p = 0.1). Three-year survival rate was 95.1% ± 2.9% in DES group and 99.5% ± 0.5% in OPCAB group (p = 0.075). Survival free from MACCE at 3 years was 73.3% ± 5.3% in DES group and 91.3% ± 2.9% in OPCAB group (p < 0.001). The major event for the differences between the groups was target vessel revascularization (p < 0.001): 21 DES patients (10.8%) vs 6 OPCAB patients (3.1%).

Conclusions: OPCAB showed better clinical outcome in 12-month and cumulative MACCE rate in 3-vessel coronary artery diseases. The major factor for the difference was target vessel revascularization. Longer follow-up is needed to clarify the differences between the two groups.