Published Online
on December 1, 2003

A more recent version of this article appeared on December 9, 2003

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Submitted on March 6, 2003
Revised on September 4, 2003
Accepted on September 8, 2003

Randomized Comparison Between Stenting and Off-Pump Bypass Surgery in Patients Referred for Angioplasty

Frank Eefting MD, Hendrik Nathoe MD, Diederik van Dijk MD, Erik Jansen MD, Jaap Lahpor MD, Pieter Stella MD, Willem Suyker MD, Jan Diephuis MD, Harry Suryapranata MD, Sjef Ernst MD, Cornelius Borst PhD, Erik Buskens PhD, Diederick Grobbee PhD, and Peter de Jaegere MD^*

From the Department of Cardiology, Heart Lung Center Utrecht (F.E., H.N., P.S., C.B., S.E., P.J.), Departments of Anesthesiology (D.D., J.D.) and Cardiothoracic Surgery (E.J., J.L.), and The Julius Center for Health Science and Primary Care (E.B., D.G.), Utrecht, the Netherlands; and Isala Clinics, Department of Cardiothoracic Surgery (W.S., H.S.), Zwolle, the Netherlands.

^* To whom correspondence should be addressed. E-mail: p.p.t.dejaegere{at}hli.azu.nl.

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.

Key words: bypass • stents • cost-benefit analysis

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