Korean J Thorac Cardiovasc Surg.  2008 Apr;41(2):202-209.

Off-pump Coronary Artery Bypass Surgery Versus Drug Eluting Stent for Multi-vessel Coronary Artery Disease

• Lee JH
• Kim KB
• Cho KR
• Park JS
• Kang HJ
• Koo BK
• Kim HS
• Sohn DW
• Oh BH
• Park YB

Abstract

BACKGROUND: The introduction of Drug Eluting Stents (DES) decreased the number of patients referred for coronary artery bypass grafting (CABG). The impact of DES on CABG (Step 1) was studied and compared with the 1-year outcome after CABG with DES (Step 2). MATERIAL AND METHOD: Surgical results for patients who underwent off-pump CABG (OPCAB) before the introduction of DES(n=298) were compared with those who underwent OPCAB after the introduction of DES (n=288) (Step 1). Postoperative 30-day and 1-year results were also compared between the patients who underwent percutaneous coronary intervention (PCI) using DES (n=220) and those who underwent OPCAB (n=255) (Step 2). RESULT: Since the introduction of DES, the ratio of CABG versus PCI decreased. In the CABG group, the number of high risk patients such as elderly patients (age 62 vs. 64, p=0.023), those with chronic renal failure (4% vs. 9%, p=0.021), calcification of the ascending aorta (9% vs. 15%, p=0.043), or frequency of urgent or emergent operations (12% vs. 22%, p=0.002) increased. However, there were no differences in the cardiac death and graft patency rates between the two groups (step 1). During the one-year follow up period, the rate of target vessel revascularization (12.3% vs. 2.4%, p<0.001) and major adverse cardiac events (MACE: death, myocardial infarct, TVR) were higher in the DES than the CABG group (13.6% vs 4.3%) (stage 2).
CONCLUSION
Introduction of DES decreased the number of patients referred for surgery, and increased the comorbidity in patients who underwent CABG. DES increased the rate of target vessel revascularization, and the occurrence of MACE during the 1-year follow-up. However, there was no difference in the incidence of myocardial infarction and cardiac death between the two groups.

Keyword

Off-pump; Coronary artery bypass surgery; Stents

MeSH Terms

Aged
Aorta
Comorbidity
Coronary Artery Bypass
Coronary Artery Bypass, Off-Pump
Coronary Artery Disease
Coronary Vessels
Death
Drug-Eluting Stents
Follow-Up Studies
Glycosaminoglycans
Humans
Incidence
Kidney Failure, Chronic
Myocardial Infarction
Percutaneous Coronary Intervention
Stents
Transplants
Glycosaminoglycans