Guest Perspectives on the Ischemia and EXCEL Trials

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In a recent Cardiology article, Nick Curzen, BM (Hons), PhD, FRCP, comments that the ISCHEMIA is a helpful trial and should prevent unnecessary revascularization in patients whose angina is well treated by optimal medical therapy alone.

However, like all trials, he notes that it is extremely important we all abide by some fundamental rules of engagement, regardless of our subspecialty interests, when we extrapolate the results into our daily practice. Read more.

In another article, Robert A. Guyton, MD, FACC, comments that EXCEL was prompted by the excellent outcomes of PCI vs. CABG in the subgroups with low and intermediate LM disease in the SYNTAX trial.

He adds that EXCEL extends that survival benefit to patients with LM disease and limited additional disease, a situation conceptually ideal for PCI. Discussion of this survival benefit, including the 30%+ relative excess mortality of PCI at five years in EXCEL, is now an essential part of shared decision-making with these patients. Read more.

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