Author + information
- Aung Myat1,
- David Hildick-Smith2,
- Adam De Belder3,
- Uday Trivedi2,
- Marie-Claude Morice4,
- David Kandzari5,
- Nicholas Lembo6,
- William Brown7,
- Patrick Serruys8,
- A. Pieter Kappetein9,
- Joseph Sabik10 and
- Gregg Stone11
- 1Brighton and Sussex Medical School, Brighton, United Kingdom
- 2Royal Sussex County Hospital, Brighton, United Kingdom
- 3Brighton and Sussex University Hospitals, Overijse, United Kingdom
- 4CERC, Massy, France
- 5Piedmont Heart Institute, Atlanta, Georgia, United States
- 6Columbia University, New York, New York, United States
- 7Piedmont Heart Institute CardioThoracic Surgeons, Atlanta, Georgia, United States
- 8Imperial College, London, United Kingdom
- 9Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- 10Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, United States
- 11Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
The international EXCEL trial reported similar 3-year outcomes for the primary endpoint of death, stroke, or MI after PCI with everolimus-eluting stents vs CABG in pts with left main coronary artery disease (LMCAD). Whether the outcomes are consistent for United States (US) operators, who have less experience with LM PCI, is unknown.
We performed a pre-specified subgroup analysis in EXCEL of participating sites in the US vs those outside the US (OUS).
Of the 1905 pts randomized, 549 (29%) were recruited in the US, and 1356 were enrolled from OUS (predominantly Europe, n=1075). US compared with non-US operators more frequently used femoral access (92.3% vs 64.9%; p<0.0001), planned hemodynamic support during PCI (11.1% vs 2.8%; p<0.0001), and IVUS (26.6% vs OUS 16.1%; p<0.0001). US centers enrolled more ostial LM lesions (39.2% vs 32.7%; p=0.007), and fewer LM distal bifurcation lesions (22.2% vs 39.7%; p<0.0001). Off-pump CABG was performed less often in the US (15.3% vs 34.9%; p<0.0001). 3-year outcomes by center appear in the Table.
There was substantial geographical variation in anatomical and procedural characteristics associated with LMCAD revascularization in the EXCEL trial. Nonetheless, the relative outcomes of PCI vs CABG were consistent between US and OUS centers.
CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)