Author + information
- Xin Huang1,
- Bjorn Redfors2,
- Shmuel Chen3,
- Yangbo Liu2,
- Ori Ben-Yehuda4,
- David Kandzari5,
- Roxana Mehran6,
- Ad van Boven7,
- Piet Willem Boonstra8,
- Joseph Sabik9,
- Patrick Serruys10,
- A. Pieter Kappetein11 and
- Gregg Stone12
- 1Cardiovascular Research Foundation, NY, Armenia
- 2Cardiovascular Research Foundation, New York, New York, United States
- 3CRF, New York, New York, United States
- 4Cardiovascular Research Foundation, Columbia University Medical Center, New York, New York, United States
- 5Piedmont Heart Institute, Atlanta, Georgia, United States
- 6Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York, United States
- 7Medisch Centrum Leeuwarden, Haren, Netherlands
- 8Medisch Centrum Leeuwarden, Heart Center, Leeuwarden PObox 888, Netherlands
- 9Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, United States
- 10Imperial College, London, United Kingdom
- 11Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- 12Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
In the EXCEL trial, PCI with everolimus-eluting stents was non-inferior to CABG at 3 years for treatment of left main coronary artery disease (LMCAD) with low or intermediate SYNTAX scores. We sought to assess whether chronic obstructive pulmonary disease (COPD), an independent risk factor for worse outcomes after surgery, affected outcomes in EXCEL.
Pts with COPD were matched 1:5 to those without COPD using propensity scores. Outcomes at 30 days and 3 years in both groups were compared in pts randomized to PCI vs. CABG.
146/1905 randomized pts (8%) in EXCEL had COPD at baseline. Propensity score matching yielded 130 pts with and 650 pts without COPD. Pts with COPD had higher rates of death, MI and stent thrombosis or graft occlusion, but not bleeding or revascularization (Table). The presence vs absence of COPD did not significantly moderate the relative risk of the primary composite endpoint of death, MI, or stroke with PCI vs. CABG at 30 days (HR 0.41; 95% CI 0.13-1.29 vs. HR 0.39; 95% CI 0.18-0.86; Pinteraction=0.97) or at 3 years (HR 0.88; 95% CI 0.46-1.68 vs. HR 1.16; 95% CI 0.77-1.74; Pinteraction=0.46).
COPD is an independent predictor of poor prognosis after LMCAD revascularization. In the EXCEL trial, early and late outcomes of PCI vs. CABG were consistent in pts with and without COPD.
CORONARY: PCI Outcomes