Open AccessRandomized Comparison Between Stenting and Off-Pump Bypass Surgery in Patients Referred for Angioplasty
Author(s) -
Frank D. Eefting,
Hendrik M. Nathoe,
Diederik van Dijk,
Erik Jansen,
Jaap R. Lahpor,
Pieter R. Stella,
Willem J.L. Suyker,
Jan C. Diephuis,
Harry Suryapranata,
Sjef M.P.G. Ernst,
Cornelius Borst,
Erik Buskens,
Diederick E. Grobbee,
Peter de Jaegere
Publication year - 2003
Publication title -
circulation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 7.795
H-Index - 607
eISSN - 1524-4539
pISSN - 0009-7322
DOI - 10.1161/01.cir.0000100723.50363.2c
Subject(s) - medicine , angioplasty , bypass surgery , surgery , revascularization , balloon , cardiopulmonary bypass , myocardial infarction , cardiac surgery , stent , cardiology , artery
Background— Stenting improves cardiac outcome in comparison with balloon angioplasty. Compared with conventional surgery, off-pump bypass surgery on the beating heart without cardiopulmonary bypass may reduce morbidity, hospital stay, and costs. The purpose, therefore, was to compare cardiac outcome, quality of life, and cost-effectiveness 1 year after stenting and after off-pump surgery.Methods and Results— Patients referred for angioplasty (n=280) were randomly assigned to stenting (n=138) or off-pump bypass surgery. At 1 year, survival free from stroke, myocardial infarction, and repeat revascularization was 85.5% after stenting and 91.5% after off-pump surgery (relative risk, 0.93; 95% CI, 0.86 to 1.02). Freedom from angina was 78.3% after stenting and 87.0% after off-pump surgery (P =0.06). Quality-adjusted lifetime was 0.82 year after stenting and 0.79 year after off-pump surgery (P =0.09). Hospital stay after the initial procedure was 1.43 and 5.77 days, respectively (P <0.01). Stenting reduced overall costs by $2933 (26.2%) per patient ($8276 versus $11 209;P <0.01). Stenting was more cost-effective in 95% of the bootstrap estimates.Conclusions— At 1 year, stenting was more cost-effective than off-pump surgery while maintaining comparable cardiac outcome and quality of life. Stenting rather than off-pump surgery, therefore, can be recommended as a first-choice revascularization strategy in selected patients.