Author + information
- Jamie Diamond1,
- Mahesh Madhavan1,
- Joseph Sabik2,
- Patrick Serruys3,
- A. Pieter Kappetein4,
- Martin Leon5,
- Jacques Berland6,
- Marie-Claude Morice7,
- Bernard Gersh8,
- David Kandzari9,
- Ovidiu Dressler10 and
- Gregg Stone11
- 1New York-Presbyterian Hospital/ Columbia University Medical Center, New York, New York, United States
- 2Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, United States
- 3Imperial College, London, United Kingdom
- 4Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- 5Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
- 6Clinique St. Hilaire, Rouen, France
- 7CERC, Massy, France
- 8Mayo Clinic, Rochester, Minnesota, United States
- 9Piedmont Heart Institute, Atlanta, Georgia, United States
- 10Cardiovascular Research Foundation, New York, New York, United States
- 11Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
Patients with cerebrovascular disease (CEVD) requiring revascularization are often referred to PCI rather than CABG. There is a paucity of data regarding the impact of cerebrovascular disease in pts with left main coronary artery disease (LMCAD) following revascularization.
In the EXCEL trial, pts with LMCAD and low or intermediate SYNTAX scores were randomized to PCI with everolimus-eluting stents vs CABG. We assessed the effect of prior CEVD, defined as prior stroke, TIA, or carotid artery disease (stent, endarterectomy, or stenosis) on the primary composite endpoint of all-cause death, stroke, or MI at 3 years. Multivariable analysis was performed to determine whether prior CEVD was an independent predictor of adverse outcomes.
Prior CEVD was present in 233/1898 pts (12.3%). These pts were older and had substantially more comorbidities, including more hypertension, diabetes, peripheral vascular ds., chronic kidney ds., and prior PCI, compared to those without prior CEVD. Pts with prior CEVD had higher 3-year rates of the primary endpoint (25.5% vs. 13.7%, adjusted HR 1.74, 95%CI 1.26-2.40, p=0.0007). The relative effects of PCI vs CABG were consistent in pts with vs without prior CEVD (Table).
Pts with LMCAD and prior cerebrovascular diseases have reduced event-free survival after revascularization compared to pts without cerebrovascular disease. Data from the EXCEL trial do not a priori support a preferential role of PCI over CABG in pts with cerebrovascular ds.
CORONARY: PCI Outcomes