Author + information
- Matias Yudi1,
- Roxana Mehran2,
- Usman Baber2,
- Aaron Crowley3,
- Ori Ben-Yehuda4,
- Emanuele Barbato5,
- Bernard Stockman6,
- Joseph Sabik7,
- Patrick Serruys8,
- A. Pieter Kappetein9 and
- Gregg Stone10
- 1Mount Sinai Health System, New York, New York, United States
- 2Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York, United States
- 3Cardiovascular Research Foundation, Queens, New York, United States
- 4Cardiovascular Research Foundation, Columbia University Medical Center, New York, New York, United States
- 5Cardiovascular Research Center Aalst OLV Hospital, Aalst, Belgium
- 6OLV Ziekenhuis Aalst, Aalst, Belgium
- 7Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, United States
- 8Imperial College, London, United Kingdom
- 9Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- 10Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
A family history of premature coronary artery disease (FHx-PCAD) is a well-described, independent risk factor for developing CAD. However, it is unclear whether FHx-PCAD has a significant impact on outcomes in patients with significant left main coronary artery disease (LMCAD) who are treated with either bypass surgery or stenting.
We analyzed data from the EXCEL trial in which patients with LMCAD and low or intermediate SYNTAX scores were randomized to PCI with everolimus-eluting stents vs. CABG. We examined outcomes by the presence or absence of FHx-PCA, defined as symptomatic CAD in first degree relatives aged <60 years. The primary endpoint was the composite rate of major adverse cardiovascular events (MACE; death, MI or stroke) at 3 years calculated by the Kaplan-Meier method.
1050 of 1590 patients (66%) had a FHx-PCAD. These patients were more likely to be male (81.4% vs. 70.0%), have renal impairment (18.4% vs. 11.4%) and diffuse small vessel disease (7.6% vs. 3.6%; all p<0.001). At three years, there was no difference in mortality (6.8% vs. 4.6%, p=0.12), myocardial infarction (8.2% vs. 9.2%, p=0.44), stroke (2.6% vs. 3.3%, p=0.36) or MACE (20.9% vs. 19.8%, p=0.74) in patients with or without a FHx-PCAD. By Cox proportional hazard modelling, FHx-PCAD was not an independent predictor of 3-year MACE (HR 1.04, 95% CI 0.81-1.32, p=0.78). The 3-year rate of MACE was consistent in patients randomized to PCI vs. CABG in those with (24.9% vs. 16.7%, HR [95%CI] = 1.45 [1.10-1.91]) and without (20.0% vs. 19.7%, HR [95%CI] = 1.01 [0.69-1.49]) a FHx-PCAD (Pinteraction=0.14).
In the EXCEL trial, FHx-PCAD was not an independent correlate of MACE at 3-years after revascularization in LMCAD. The outcomes after PCI and CABG were consistent in patients with and without a FHx-PCAD.
CORONARY: PCI Outcomes