Randomized comparison between stenting and off-pump bypass surgery in patients referred for angioplasty

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.