EXCEL: No Significant Outcome Differences in PCI vs CABG for Left Main Coronary Disease at Five Years

Findings from EXCEL presented Sept. 28 during TCT 2019 suggest no significant difference between percutaneous coronary intervention (PCI) with contemporary drug-eluting stents, as compared with coronary artery bypass grafting (CABG) in terms of major adverse cardiovascular events at five years. The trial results, which were also published in the New England Journal of Medicine, focused on patients with left main coronary artery disease of low or intermediate anatomical complexity.

Gregg W. Stone, MD, FACC, and colleagues randomly assigned 1,905 patients to undergo either PCI with fluoropolymer-based cobalt–chromium everolimus-eluting stents (n=948 patients) or CABG (n=957 patients). The primary outcome was a composite of death, stroke or myocardial infarction (MI).

Results at five years showed a primary outcome event had occurred in 22.0 percent of the patients in the PCI group and in 19.2 percent of the patients in the CABG group. Death from any cause occurred more frequently in the PCI group than in the CABG group (13.0 percent vs. 9.9 percent, respectively). However, the incidences of definite cardiovascular death (5.0 percent and 4.5 percent) and MI (10.6 percent and 9.1 percent) were not significantly different between the two groups. Additionally, ischemia-driven revascularization was more frequent after PCI than after CABG (16.9 percent vs. 10.0 percent).

In terms of cerebrovascular events, all events were less frequent after PCI compared with after CABG (3.3 percent vs. 5.2 percent). However, researchers noted the incidence of stroke was not significantly different between the two groups (2.9 percent and 3.7 percent).

"In the present trial we did not find a significant difference between PCI and CABG with respect to rates of the composite outcome of death, stroke, or myocardial infarction at five years among patients with left main coronary artery disease and low or intermediate anatomical complexity," Stone and colleagues said. However, the suggest 10-year (or longer) follow-up is needed "to characterize the very late safety profiles of PCI and CABG, since both stents and bypass grafts progressively fail over time."

Keywords: TCT19, Transcatheter Cardiovascular Therapeutics, Angiography, Percutaneous Coronary Intervention, Coronary Artery Disease, Coronary Artery Bypass

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