Outcomes of left main revascularization in patients with acute coronary syndromes and stable ischemic heart disease: Analysis from the EXCEL trial

Serge Doucet, E. Marc Jolicœur, Patrick W. Serruys, Michael Ragosta, Irving L. Kron, Werner Scholtz, Jochen Börgermann, Yiran Zhang, Thomas McAndrew, Joseph F. Sabik, Arie Pieter Kappetein, Gregg W. Stone

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Prompt revascularization is often required in acute coronary syndromes (ACS), whereas stable ischemic heart disease (SIHD) may allow for more measured procedural planning. Whether the acuity of presentation preferentially affects outcomes after coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with left main coronary artery disease (LMCAD) is unknown. We investigated whether the acuity of presentation discriminated patients who derived a differential benefit from PCI versus CABG in the randomized Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial. Methods: We used multivariable Cox models to assess the interaction between the acuity of presentation, type of revascularization and outcomes in patients with low or intermediate SYNTAX scores enrolled in EXCEL. Results: At baseline, 1151 patients (60.7%) presented with SIHD and 746 patients (39.3%) presented with an ACS. The acuity of presentation was not associated with the primary endpoint of all-cause death, MI, or stroke at 3 years (multivariable adjusted hazard ratio [HR] 0.94; 95% CI 0.70–1.26, P = .64). The primary endpoint rate was similar in patients assigned to PCI versus CABG whether they presented with SIHD (adjusted HR 1.04; 95% CI 0.73–1.48]) or with ACS (HR 0.82; 95% CI 0.54–1.26) (Pinteraction = .34). Conclusions: The acuity of presentation did not predict outcomes in patients with LMCAD undergoing revascularization, nor did it discriminate patients who derive greater event-free survival from PCI versus CABG.

Original languageEnglish (US)
Pages (from-to)9-17
Number of pages9
JournalAmerican Heart Journal
Volume214
DOIs
StatePublished - Aug 2019
Externally publishedYes

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Acute Coronary Syndrome
Myocardial Ischemia
Coronary Artery Bypass
Percutaneous Coronary Intervention
Coronary Artery Disease
Proportional Hazards Models
Disease-Free Survival
Cause of Death
Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Outcomes of left main revascularization in patients with acute coronary syndromes and stable ischemic heart disease : Analysis from the EXCEL trial. / Doucet, Serge; Jolicœur, E. Marc; Serruys, Patrick W.; Ragosta, Michael; Kron, Irving L.; Scholtz, Werner; Börgermann, Jochen; Zhang, Yiran; McAndrew, Thomas; Sabik, Joseph F.; Kappetein, Arie Pieter; Stone, Gregg W.

In: American Heart Journal, Vol. 214, 08.2019, p. 9-17.

Research output: Contribution to journalArticle

Doucet, S, Jolicœur, EM, Serruys, PW, Ragosta, M, Kron, IL, Scholtz, W, Börgermann, J, Zhang, Y, McAndrew, T, Sabik, JF, Kappetein, AP & Stone, GW 2019, 'Outcomes of left main revascularization in patients with acute coronary syndromes and stable ischemic heart disease: Analysis from the EXCEL trial', American Heart Journal, vol. 214, pp. 9-17. https://doi.org/10.1016/j.ahj.2019.04.016
Doucet, Serge ; Jolicœur, E. Marc ; Serruys, Patrick W. ; Ragosta, Michael ; Kron, Irving L. ; Scholtz, Werner ; Börgermann, Jochen ; Zhang, Yiran ; McAndrew, Thomas ; Sabik, Joseph F. ; Kappetein, Arie Pieter ; Stone, Gregg W. / Outcomes of left main revascularization in patients with acute coronary syndromes and stable ischemic heart disease : Analysis from the EXCEL trial. In: American Heart Journal. 2019 ; Vol. 214. pp. 9-17.
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abstract = "Background: Prompt revascularization is often required in acute coronary syndromes (ACS), whereas stable ischemic heart disease (SIHD) may allow for more measured procedural planning. Whether the acuity of presentation preferentially affects outcomes after coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with left main coronary artery disease (LMCAD) is unknown. We investigated whether the acuity of presentation discriminated patients who derived a differential benefit from PCI versus CABG in the randomized Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial. Methods: We used multivariable Cox models to assess the interaction between the acuity of presentation, type of revascularization and outcomes in patients with low or intermediate SYNTAX scores enrolled in EXCEL. Results: At baseline, 1151 patients (60.7{\%}) presented with SIHD and 746 patients (39.3{\%}) presented with an ACS. The acuity of presentation was not associated with the primary endpoint of all-cause death, MI, or stroke at 3 years (multivariable adjusted hazard ratio [HR] 0.94; 95{\%} CI 0.70–1.26, P = .64). The primary endpoint rate was similar in patients assigned to PCI versus CABG whether they presented with SIHD (adjusted HR 1.04; 95{\%} CI 0.73–1.48]) or with ACS (HR 0.82; 95{\%} CI 0.54–1.26) (Pinteraction = .34). Conclusions: The acuity of presentation did not predict outcomes in patients with LMCAD undergoing revascularization, nor did it discriminate patients who derive greater event-free survival from PCI versus CABG.",
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T1 - Outcomes of left main revascularization in patients with acute coronary syndromes and stable ischemic heart disease

T2 - Analysis from the EXCEL trial

AU - Doucet, Serge

AU - Jolicœur, E. Marc

AU - Serruys, Patrick W.

AU - Ragosta, Michael

AU - Kron, Irving L.

AU - Scholtz, Werner

AU - Börgermann, Jochen

AU - Zhang, Yiran

AU - McAndrew, Thomas

AU - Sabik, Joseph F.

AU - Kappetein, Arie Pieter

AU - Stone, Gregg W.

PY - 2019/8

Y1 - 2019/8

N2 - Background: Prompt revascularization is often required in acute coronary syndromes (ACS), whereas stable ischemic heart disease (SIHD) may allow for more measured procedural planning. Whether the acuity of presentation preferentially affects outcomes after coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with left main coronary artery disease (LMCAD) is unknown. We investigated whether the acuity of presentation discriminated patients who derived a differential benefit from PCI versus CABG in the randomized Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial. Methods: We used multivariable Cox models to assess the interaction between the acuity of presentation, type of revascularization and outcomes in patients with low or intermediate SYNTAX scores enrolled in EXCEL. Results: At baseline, 1151 patients (60.7%) presented with SIHD and 746 patients (39.3%) presented with an ACS. The acuity of presentation was not associated with the primary endpoint of all-cause death, MI, or stroke at 3 years (multivariable adjusted hazard ratio [HR] 0.94; 95% CI 0.70–1.26, P = .64). The primary endpoint rate was similar in patients assigned to PCI versus CABG whether they presented with SIHD (adjusted HR 1.04; 95% CI 0.73–1.48]) or with ACS (HR 0.82; 95% CI 0.54–1.26) (Pinteraction = .34). Conclusions: The acuity of presentation did not predict outcomes in patients with LMCAD undergoing revascularization, nor did it discriminate patients who derive greater event-free survival from PCI versus CABG.

AB - Background: Prompt revascularization is often required in acute coronary syndromes (ACS), whereas stable ischemic heart disease (SIHD) may allow for more measured procedural planning. Whether the acuity of presentation preferentially affects outcomes after coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with left main coronary artery disease (LMCAD) is unknown. We investigated whether the acuity of presentation discriminated patients who derived a differential benefit from PCI versus CABG in the randomized Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial. Methods: We used multivariable Cox models to assess the interaction between the acuity of presentation, type of revascularization and outcomes in patients with low or intermediate SYNTAX scores enrolled in EXCEL. Results: At baseline, 1151 patients (60.7%) presented with SIHD and 746 patients (39.3%) presented with an ACS. The acuity of presentation was not associated with the primary endpoint of all-cause death, MI, or stroke at 3 years (multivariable adjusted hazard ratio [HR] 0.94; 95% CI 0.70–1.26, P = .64). The primary endpoint rate was similar in patients assigned to PCI versus CABG whether they presented with SIHD (adjusted HR 1.04; 95% CI 0.73–1.48]) or with ACS (HR 0.82; 95% CI 0.54–1.26) (Pinteraction = .34). Conclusions: The acuity of presentation did not predict outcomes in patients with LMCAD undergoing revascularization, nor did it discriminate patients who derive greater event-free survival from PCI versus CABG.

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