• Daniel Bainbridge, Davy Cheng, Janet Martin, Richard Novick, and Evidence-based Peri-operative Clinical Outcomes Research (EPiCOR) Group.
• Department of Anesthesia & Perioperative Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
• J. Thorac. Cardiovasc. Surg. 2007 Mar 1;133(3):623-31.

ObjectiveTo determine, through meta-analysis, whether off-pump coronary artery bypass, including minimally invasive off-pump coronary artery bypass, improves short-term and midterm outcomes compared with percutaneous coronary intervention for single- or double-vessel coronary artery disease.MethodsThe primary outcome was need for coronary reintervention at 1 to 5 years. Secondary outcomes included all major clinical morbidities and resource utilization. A comprehensive search was undertaken to identify all randomized trials of off-pump coronary artery bypass versus percutaneous coronary intervention. MEDLINE, Cochrane Library, EMBASE, and abstract databases were searched up to May 2006. All randomized trials comparing off-pump coronary artery bypass (sternotomy or minimally invasive) versus percutaneous coronary intervention and reporting at least one predefined outcome were included. Odds ratios (OR, 95% confidence intervals [CI]) and weighted mean differences (WMD, 95% CI) were analyzed.ResultsSix trials involving 989 patients were included. Compared with percutaneous coronary intervention, off-pump coronary artery bypass decreased angina recurrence (OR 0.54, 95% CI 0.34-0.87) and need for reintervention at 1 to 5 years (OR 0.24, 95% CI 0.15-0.40). Major adverse coronary events were significantly reduced (OR 0.44, 95% CI 0.30-0.63) and event-free survival was significantly increased at 1 to 5 years (OR 2.32, 95% CI 1.62-3.32) for off-pump coronary artery bypass versus percutaneous coronary intervention. Coronary stenosis at 6 months was reduced with off-pump coronary artery bypass compared with percutaneous coronary intervention (OR 0.31, 95% CI 0.18-0.55). Hospital stay was significantly increased with off-pump coronary artery bypass versus percutaneous coronary intervention (WMD 4.03, 95% CI 2.37-5.70). Quality of life favored off-pump coronary artery bypass in some domains but was reported in few studies. Death, myocardial infarction, and stroke did not significantly differ.ConclusionsIn single- or double-vessel disease, off-pump coronary artery bypass improved short-term and midterm clinical outcomes compared with percutaneous coronary intervention but was associated with an increased length of hospital stay.

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