Author + information
- Matias Yudi1,
- Roxana Mehran2,
- Usman Baber2,
- Aaron Crowley3,
- Ori Ben-Yehuda4,
- A. Pieter Kappetein5,
- Joseph Sabik6,
- Patrick Serruys7 and
- Gregg Stone8
- 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
- 5Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- 6Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, United States
- 7Imperial College, London, United Kingdom
- 8Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
Patients with previously documented coronary artery disease (CAD) are at high risk for future cardiovascular events. The prognostic significance of established CAD in patients presenting with significant left main (LM) disease requiring revascularization is unknown.
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 (EES) vs. CABG. Outcomes were examined according to the presence or absence of established CAD, defined as a history of previous MI or revascularization. The primary endpoint was major adverse cardiovascular events (MACE; death, MI or stroke) at 3 years calculated by the Kaplan-Meier method.
503/1886 patients (26.7%) had established CAD; 65.2% had prior MI and 63.8% had undergone prior revascularization. These patients were older (67.7±9.0 vs. 65.3±9.7, p<0.001), had higher rate of diabetes, hypertension, stroke, peripheral vascular disease, and renal impairment, and were more likely to present with recent MI and with a higher SYNTAX score (all p<0.05). 3-year MACE occurred in a similar proportion of patients with vs. without established CAD in unadjusted analysis (23.9%. vs. 20.0%, p=0.13), and after multivariable adjustment (HR 1.18, 95% CI 0.94-1.48, p=0.15). 3-year MACE rates were similar and consistent after PCI vs. CABG in patients with (25.3% vs. 22.4%, HR 1.12; 95% CI 0.77-1.62) and without (22.1% vs. 18.0%, HR 1.20; 95% CI 0.94-1.53) (Pinteraction=0.74).
In the EXCEL trial, despite a greater burden of co-morbidities and high-risk features, patients with established CAD who presented with LMCAD requiring revascularization had a similar 3-year prognosis as those without established CAD, with comparable rates of MACE after PCI with EES and CABG.
CORONARY: PCI Outcomes