EXCEL: PCI With EES vs. CABG For Left Main Artery Disease

Percutaneous coronary intervention (PCI) with everolimus-eluting stents (EES) was noninferior to coronary artery bypass grafting (CABG), according to the results of the EXCEL Trial presented Oct. 31 at TCT 2016 and simultaneously published in the New England Journal of Medicine.

G.W. Stone, MD, FACC, et al., conducted a multi-center, randomized trial of 1905 patients with left main artery disease to assess whether a drug-eluting stent could be an acceptable alternative to CABG. 948 patients underwent PCI with fluoropolymer-based cobalt-chromium EES, while 957 underwent CABG. The primary endpoint was the rate of composite death from any cause, stroke, or myocardial infarction at 3 years.

The results of the study showed that at three years, the primary endpoint was similar between those patients undergoing PCI with EES (15.4 percent) and those undergoing CABG (14.7 percent).

Stone, et al., note that “the results of [the trial] suggest that PCI with EES is an acceptable or perhaps preferred alternative to CABG in selected patients with left main coronary artery disease who are candidates for either procedure.”

In an accompanying editorial comment, Eugene Braunwald, MD, MACC, adds that “the outcomes of shorter hospital stay, greater early safety benefit, and more rapid recovery and return to normal activity favor PCI over CABG. However … it should be noted that the PCI group exhibited a greater increase in [death, stroke and myocardial infarction] between 30 days and three years than the CABG group did (11.5 percent vs. 7.9 percent). Therefore, it is reassuring that the EXCEL investigators plan further follow-up of these patients.”

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Aortic Surgery, Interventions and Coronary Artery Disease

Keywords: Transcatheter Cardiovascular Therapeutics, Coronary Artery Bypass, Coronary Artery Disease, Drug-Eluting Stents, Patient Selection, Stents, Arteries, Chromium, Cobalt, Follow-Up Studies, Myocardial Infarction, Percutaneous Coronary Intervention, Stroke


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