Off-pump coronary artery bypass grafting versus percutaneous coronary intervention with second-generation drug-eluting stents for coronary artery revascularization.

Objective: This study compared the clinical efficacy of off-pump coronary artery bypass grafting (OPCAB) with percutaneous coronary intervention (PCI) in the treatment of left main coronary artery and/or triple-vessel disease (LM and/or TVD).

Methods: We retrospectively enrolled 1484 consecutive patients with LM and/or TVD in Shanxi Cardiovascular Hospital from January 2015 to December 2022 and divided them into the OPCAB group (n = 583) and the PCI group (with second-generation drug-eluting stents) (n = 901). Propensity score matching was used for 316 equally matched pairs of patients in the groups. The outcomes were all-cause and cardiac mortality, angina recurrence, and major adverse cardiac and cerebrovascular events, which comprised non-lethal myocardial infarction, stroke, and repeat revascularization.

Results: The mean follow-up was 3.93 years in the OPCAB group and 4.19 years in the PCI group. There were no significant differences in all-cause mortality, cardiac mortality, major adverse cardiac and cerebrovascular events, or non-lethal myocardial infarction between the groups. The incidence of repeat revascularization and angina recurrence was higher in the PCI group than in the OPCAB group. However, the incidence of stroke was higher in the OPCAB group than in the PCI group.

Conclusions: OPCAB may be a favorable coronary revascularization strategy for LM and/or TVD.