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Outcomes After Left Main Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting According to Lesion Site Results From the EXCEL Trial Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease Design and rationale for a randomised comparison of everolimus-eluting stents and coronary artery bypass graft surgery in selected patients with left main coronary artery disease: the EXCEL trial Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial Left Main Revascularization With PCI or CABG in Patients With Chronic Kidney Disease: EXCEL Trial Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial Current treatment of significant left main coronary artery disease: A review Quality of Life after Everolimus-Eluting Stents or Bypass Surgery for Treatment of Left Main Disease

Clinical Trial2020 Jun 27.

JOURNAL:Catheter Cardiovasc Interv . Article Link

Impact of Lesion Preparation Strategies on Outcomes of Left Main PCI: The EXCEL Trial

N Beohar, S Chen, GW Stone et al. Keywords: lesion preparation left main coronary artery; PCI

ABSTRACT

OBJECTIVES - We examined outcomes according to lesion preparation strategy (LPS) in patients with left main coronary artery (LMCA) percutaneous coronary intervention (PCI) in the EXCEL trial.

 

BACKGROUND - The optimal LPS for LMCA PCI is unclear.

 

METHODS - We categorized LPS hierarchically (high to low) as: (a) rotational atherectomy (RA); (b) cutting or scoring balloon (CSB); (c) balloon angioplasty (BAL); and d) direct stenting (DIR). The primary endpoint was 3year MACE; allcause death, stroke, or myocardial infarction.

 

RESULTS - Among 938 patients undergoing LMCA PCI, RA was performed in 6.0%, CSB 9.5%, BAL 71.3%, and DIR 13.2%. In patients treated with DIR, BAL, CSB, and RA, respectively, there was a progressive increase in SYNTAX score, LMCA complex bifurcation, trifurcation or calcification, number of stents, and total stent length. Any procedural complication occurred in 10.4% of cases overall, with the lowest rate in the DIR (7.4%) and highest in the RA group (16.1%) (p trend = .22). There were no significant differences in the 3year rates of MACE (from RA to DIR: 17.9%, 20.2%, 14.5%, 14.7%; p = .50) or ischemiadriven revascularization (from RA to DIR: 16.8%, 10.8%, 12.3%, 14.2%; p = .65). The adjusted 3year rates of MACE did not differ according to LPS.

 

CONCLUSIONS - The comparable 3year outcomes suggest that appropriate lesion preparation may be able to overcome the increased risks of complex LMCA lesion morphology.