Author + information
- Carlos Collet1,
- Gregg Stone2,
- Nicholas Lembo3,
- Adrian Banning4,
- Martin Leon5,
- Marie-Claude Morice6,
- David Kandzari7,
- Rod Stables8,
- Yangbo Liu9,
- Ovidiu Dressler9,
- Joseph Sabik10,
- A. Pieter Kappetein11 and
- Patrick Serruys12
- 1AMC, Amsterdam, Netherlands
- 2Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
- 3Columbia University, New York, New York, United States
- 4John Radcliffe Hospital, Oxford, United Kingdom
- 5Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
- 6CERC, Massy, France
- 7Piedmont Heart Institute, Atlanta, Georgia, United States
- 8Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
- 9Cardiovascular Research Foundation, New York, New York, United States
- 10Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, United States
- 11Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- 12Imperial College, London, United Kingdom
Contemporary coronary trials include patients with complex coronary artery disease (CAD) for which treatment planning may involve interventions performed in one or more stages. Whether a staging strategy improves outcomes is unknown.
Patients with left main coronary artery disease (LMCAD) randomized to percutaneous coronary intervention (PCI) with everolimus-eluting stents (EES) in the EXCEL trial were categorized according to the treatment strategy, ie, staged PCI vs single procedure. Rates of major adverse cardiac events (MACE; all-cause death, stroke, or myocardial infarction) and major adverse cardiac or cerebrovascular events (MACCE; MACE or ischemia-driven revascularization) were compared between groups at 3-year follow-up.
944 patients undergoing LM PCI (77 staged vs 867 single procedure) were analyzed. Patients in the staged procedure group had higher anatomical SYNTAX score (25.0±4.98 vs 20.2±6.1, p<0.0001) and more lesions planned to be treated (2.5±0.8 vs 1.6±0.7, p<0.0001). Staged procedures were associated with higher use of 7Fr guiding catheters (50.6% vs 36.8%, p=0.02), less contrast (230.4±130.4 mL vs 259.7±125.5 mL, p=0.002) and more stents implanted (4.1±1.8 vs 2.3±1.3, p<0.0001). At 3 years, MACE rates were 9.1% in the staged procedure group vs 15.7% in the single procedure group (p=0.21). Three-year MACCE rates were 14.3% vs 23.8%, respectively (p=0.12). The 3-year rate of all-cause death was significantly lower in the staged procedure group (1.3% vs 8.7%, p=0.04). No significant differences were found in the other components of MACCE.
Despite higher anatomical and procedural complexity, staged procedures during left main PCI were associated with comparable rates of 3-year MACE and MACCE in patients with left main disease undergoing PCI with EES. All-cause mortality was significantly lower in the staged procedure group.
CORONARY: Stents: Drug-Eluting