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Stenting Left Main

Abstract

Recommended Article

Imaging and Physiology Get Along in the Left Main Coronary Artey Disease: The Case for Intravascular Ultrasound and Instantaneous Wave-Free Ratio Predictors of Left Main Coronary Artery Disease in the ISCHEMIA Trial Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis Ten-Year All-Cause Death According to Completeness of Revascularization in Patients With Three-Vessel Disease or Left Main Coronary Artery Disease: Insights From the SYNTAX Extended Survival Study Long-Term Outcomes After PCI or CABG for Left Main Coronary Artery Disease According to Lesion Location Revascularization in Patients With Left Main Coronary Artery Disease and Left Ventricular Dysfunction Impact of Lesion Preparation Strategies on Outcomes of Left Main PCI: The EXCEL Trial Bayesian Interpretation of the EXCEL Trial and Other Randomized Clinical Trials of Left Main Coronary Artery Revascularization
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Clinical TrialAvailable online 30 October 2017

JOURNAL：J Am Coll Cardiol. Article Link

Quality of Life after Everolimus-Eluting Stents or Bypass Surgery for Treatment of Left Main Disease

SJ Baron, K Chinnakondepalli, EA. Magnuson et al. Keywords: Quality of Life; Left Main Coronary Artery Disease; Percutaneous Coronary Intervention; Bypass Surgery

ABSTRACT


Background - The EXCEL trial compared outcomes in patients with unprotected left main coronary artery disease (LMCAD) treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) using everolimus-eluting stents. While rates of death, stroke, and myocardial infarction were similar at 36 months, event timing and repeat revascularization rates differed by treatment group.


Objectives - To understand the effects of revascularization strategy from the patient’s perspective, we performed a prospective quality of life (QoL) sub-study alongside the EXCEL trial.


Methods - Between September 2010 and March 2014, 1905 patients with LMCAD were randomized to undergo CABG or PCI, of whom 1788 participated in the QoL sub-study. QoL was assessed at baseline and 1, 12, and 36 months using the Seattle Angina Questionnaire, the SF-12, the Rose Dyspnea Scale, the Patient Health Questionnaire-8, and the EQ-5D. Differences between PCI and CABG were assessed using longitudinal random-effect growth curve models.


Results - Over 36 months, both PCI and CABG were associated with significant improvements in QoL compared with baseline. At 1 month, PCI was associated with better QoL than CABG. By 12 months though, these differences were largely attenuated, and by 36 months, there were no significant QoL differences between PCI and CABG.


Conclusions - Among selected patients with LMCAD, both PCI and CABG result in similar QoL improvement through 36 months, although a greater early benefit is seen with PCI. Taken together with the 3-year clinical results of EXCEL, these findings suggest that PCI and CABG provide similar intermediate-term outcomes for patients with LMCAD.

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