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Bypass surgery or stenting for left main coronary artery disease in patients with diabetes

Authors :
José L. Pomar
Roxana Mehran
Arie Pieter Kappetein
Charles A. Simonton
Ad J. van Boven
Adrian P. Banning
Joseph F. Sabik
Anthony H. Gershlick
David E. Kandzari
Samer Mansour
Erick Schampaert
Patrick W. Serruys
Aaron Crowley
Gregg W. Stone
Nicolas Noiseux
John D. Puskas
Ferenc Horkay
Manel Sabaté
Milan Milojevic
David P. Taggart
Imre Ungi
Nicholas Lembo
Stuart J. Pocock
Philippe Généreux
Andrzej Bochenek
Ioanna Kosmidou
Ori Ben-Yehuda
Cardiothoracic Surgery
Source :
Journal of the American College of Cardiology, 73(13), 1616-1628. Elsevier Inc.
Publication Year :
2019
Publisher :
Elsevier, 2019.

Abstract

Background The randomized EXCEL (Evaluation of XIENCE versus Coronary ArteryBypass Surgeryfor Effectiveness of Left Main Revascularization) trial reported a similar rate of the 3-year composite primary endpoint ofdeath,myocardial infarction(MI), orstrokein patients with left maincoronary artery disease(LMCAD) and site-assessed low or intermediateSYNTAX scorestreated withpercutaneous coronary intervention(PCI) and coronary artery bypass grafting (CABG). Whether these results are consistent in high-riskpatients with diabetes, who have fared relatively better with CABG in most prior trials, is unknown. Objectives In this pre-specifiedsubgroup analysisfrom the EXCEL trial, the authors sought to examine the effect ofdiabetesin 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-elutingstentsversus CABG, stratified by the presence ofdiabetes. The primary endpoint was the rate of a composite of all-causedeath,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 30days (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 intermediateSYNTAX scores.(Evaluation of XIENCE versusCoronary Artery BypassSurgery for Effectiveness of Left MainRevascularization[EXCEL];NCT01205776)

Details

Language :
English
ISSN :
07351097
Database :
OpenAIRE
Journal :
Journal of the American College of Cardiology, 73(13), 1616-1628. Elsevier Inc.
Accession number :
edsair.doi.dedup.....b6f7f1942babed5dda4ad131591eb847