Bypass Surgery or Stenting for Left Main Coronary Artery Disease in Patients With Diabetes

BACKGROUND The randomized EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial reported a similar rate of the 3-year composite primary endpoint of death, myocardial infarction (MI), or stroke in patients with left main coronary art...

Full description

Saved in:
Bibliographic Details
Main Authors: Milojevic Milan
Serruys Patrick W.
Sabik Joseph F.
Kandzari David E.
Schampaert Erick
van Boven Ad J.
Horkay Ferenc
Ungi Imre
Mansour Samer
Banning Adrian P.
Taggart David P.
Sabaté Manel
Gershlick Anthony H.
Bochenek Andrzej
Pomar Jose
Format: Article
Published: 2019
Series:JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 73 No. 13
Subjects:
doi:10.1016/j.jacc.2019.01.037

mtmt:30991525
Online Access:http://publicatio.bibl.u-szeged.hu/22347
Description
Summary:BACKGROUND The randomized EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial reported a similar rate of the 3-year composite primary endpoint of death, myocardial infarction (MI), or stroke in patients with left main coronary artery disease (LMCAD) and site-assessed low or intermediate SYNTAX scores treated with percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Whether these results are consistent in high-risk patients with diabetes, who have fared relatively better with CABG in most prior trials, is unknown.OBJECTIVES In this pre-specified subgroup analysis from the EXCEL trial, the authors sought to examine the effect of diabetes in patients with LMCAD treated with PCI versus CABG.METHODS Patients (N = 1,905) with LMCAD and site-assessed low or intermediate CAD complexity (SYNTAX scores <= 32) were randomized 1: 1 to PCI with everolimus-eluting stents versus CABG, stratified by the presence of diabetes. The primary endpoint was the rate of a composite of all-cause death, stroke, or MI at 3 years. Outcomes were examined in patients with (n = 554) and without (n = 1,350) diabetes.RESULTS The 3-year composite primary endpoint was significantly higher in diabetic compared with nondiabetic patients (20.0% vs. 12.9%; p < 0.001). The rate of the 3-year primary endpoint was similar after treatment with PCI and CABG in diabetic patients (20.7% vs. 19.3%, respectively; hazard ratio: 1.03; 95% confidence interval: 0.71 to 1.50; p = 0.87) and nondiabetic patients (12.9% vs. 12.9%, respectively; hazard ratio: 0.98; 95% confidence interval: 0.73 to 1.32; p = 0.89). All-cause death at 3 years occurred in 13.6% of PCI and 9.0% of CABG patients (p = 0.046), although no significant interaction was present between diabetes status and treatment for all-cause death (p = 0.22) or other endpoints, including the 3-year primary endpoint (p = 0.82) or the major secondary endpoints of death, MI, or stroke at 30 days (p = 0.61) or death, MI, stroke, or ischemia-driven revascularization at 3 years (p = 0.65).CONCLUSIONS In the EXCEL trial, the relative 30-day and 3-year outcomes of PCI with everolimus-eluting stents versus CABG were consistent in diabetic and nondiabetic patients with LMCAD and site-assessed low or intermediate SYNTAX scores.(Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization [EXCEL]; NCT01205776) (C) 2019 Published by Elsevier on behalf of the American College of Cardiology Foundation.
Physical Description:1616-1628
ISSN:0735-1097