Author + information
- Erick Schampaert1,
- Patrick Serruys2,
- A. Pieter Kappetein3,
- Nicholas Lembo4,
- William Brown5,
- Andrzej Bochenek6,
- Pierre Page7,
- Ovidiu Dressler8,
- Roxana Mehran9,
- Joseph Sabik10 and
- Gregg Stone11
- 1Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
- 2Imperial College, London, United Kingdom
- 3Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- 4Columbia University, New York, New York, United States
- 5Piedmont Heart Institute CardioThoracic Surgeons, Atlanta, Georgia, United States
- 6Ist Department of Cardiovascular Surgery, American Heart of Poland, Bielsko-Biała, Poland
- 7Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
- 8Cardiovascular Research Foundation, New York, New York, United States
- 9Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York, United States
- 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
In the large-scale international, multicenter randomized EXCEL trial, PCI with everolimus-eluting stents (EES) was non-inferior to CABG in pts with left main coronary artery disease (LMCAD) and SYNTAX scores ≤32 at median 3-year (3Y) follow-up. Given the impact of age on outcomes after revascularization, a pre-specified analysis of PCI vs. CABG in pts age <75 or ≥75 years was performed in EXCEL.
The primary endpoint was 3Y major adverse cardiac events (MACE), a composite of death, stroke or MI. Secondary endpoints included 30-day (30D) MACE, 3Y ischemia-driven revascularization (IDR), and stent thrombosis or symptomatic graft occlusion (ST/GO).
1905 LM pts were randomized to EES (n=948) or CABG (n=957), including 1586 pts (83.3%) <75 and 319 (16.7%) ≥75 years old. Each group was equally distributed between PCI and CABG, with balanced baseline demographics. 3Y rates of MACE were lower in pts <75 vs. ≥75 years old (14.0% vs. 20.4%, p=0.008). Results in the <75 and ≥75 year old groups are shown in the Figure. The results of PCI on 30D MACE, 3Y MACE, 3Y IDR, and 3Y ST/GO were consistent in elderly and younger pts (P values for interaction = 0.84, 0.12, 0.63 and 0.36 respectively).
In the EXCEL trial, PCI resulted in lower rates of 30D MACE and 3Y ST/GO, similar rates of 3Y MACE, and higher rates of 3Y IDR in younger pts, results which were consistent in elderly and younger pts. Age need not be a major factor in heart team deliberations when selecting PCI vs. CABG in pts with LMCAD and SYNTAX scores ≤32.
CORONARY: Complex and Higher Risk Procedures for Indicated Patients (CHIP)