Author + information
- Shmuel Chen1,
- Bjorn Redfors2,
- Yangbo Liu2,
- Mathias Vrolix3,
- Carlos Macaya4,
- Ori Ben-Yehuda5,
- A. Pieter Kappetein6,
- Joseph Sabik7,
- Patrick Serruys8 and
- Gregg Stone9
- 1CRF, New York, New York, United States
- 2Cardiovascular Research Foundation, New York, New York, United States
- 3St Jan Zikenhuis ZOL, Genk, Belgium
- 4Hospital Clinico de San Carlos, Madrid, Spain
- 5Cardiovascular Research Foundation, Columbia University Medical Center, New York, New York, United States
- 6Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- 7Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, United States
- 8Imperial College, London, United Kingdom
- 9Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
Hyperlipidemia (HPL) is an important risk factor for atherosclerotic disease, and treatment with statins has been shown to reduce this risk; however, there is paucity of data regarding the effect of treated HPL in pts undergoing revascularization for left main coronary artery disease (LMCAD).
The EXCEL trial enrolled 1905 pts with LMCAD and low or intermediate SYNTAX scores to PCI with everolimus-eluting stents or CABG. Pts were categorized according to whether they had medically treated HPL, and 3-year outcomes were compared using multivariable Cox proportional hazards regression. The primary endpoint was a composite of death, MI, or stroke at 3 years.
1875 pts with known HPL status were included in the current analysis, 1320 of whom (70.4%) had HPL. Pts with HPL were older, more often male, and more frequently diabetic compared to those without HPL. There were no significant differences between PCI and CABG in the rates of the 3-year primary endpoint in pts with HPL (15.4% vs 14.8%, p=0.92) or without HPL (15.7% vs 14.2%, p=0.99) (p for interaction = 0.96) or its components. Among pts with HPL,3-year rates of ischemia-driven revascularization (IDR) were higher after PCI compared with CABG (13.8% vs 5.5%; p<0.0001), in contrast to pts without HPL (10.5% vs 12.4%; p=0.53 (Figure) (p for interaction = 0.0009). After multivariable adjustment these findings remained statistically significant.
In the EXCEL trial, the outcomes of PCI vs. CABG for LMCAD were consistent for the primary endpoint of 3-year death, MI or stroke in pts with and without HPL. However, the increase in revascularization after PCI compared to CABG was confined to pts with medically-treated HPL.
CORONARY: Lipid Disorders and Management