Author + information
- Received September 15, 2017
- Revision received October 5, 2017
- Accepted October 17, 2017
- Published online October 30, 2017.
- Suzanne J. Baron, MD, MSc∗,
- Khaja Chinnakondepalli, MS∗,
- Elizabeth A. Magnuson, ScD∗,
- David E. Kandzari, MD†,
- John D. Puskas, MD‡,
- Ori Ben-Yehuda, MD§,
- Gerrit-Anne van Es, PhDǁ,
- David P. Taggart, MD¶,
- Marie-Claude Morice, MD#,
- Nicholas J. Lembo, MD‡,
- W. Morris Brown III, MD‡,
- Adrian Banning, MD¶,
- Charles A. Simonton, MD∗∗,
- A. Pieter Kappetein, MD PhD††,
- Joseph F. Sabik, MD‡‡,
- Patrick W. Serruys, MD PhD§§,
- Gregg W. Stone, MDǁǁ,
- David J. Cohen, MD MSc∗∗ (, )
- on behalf of the EXCEL Investigators
- ∗Saint Luke’s Mid America Heart Institute, University of Missouri-Kansas City School of 2/2Medicine, Kansas City, MO
- †Piedmont Heart Institute, Atlanta, GA
- ‡Mount Sinai Medical Center, New York, NY
- §Cardiovascular Research Foundation, New York, NY
- ǁCardialysis, Rotterdam, the Netherlands
- ¶Oxford University Hospitals, Oxford, UK
- #Ramsay Générale de Santé, Hospital Privé Jacques Cartier, Massy, France
- ∗∗Abbott Vascular Inc, Abbott Park, IL
- ††Erasmus Medical Center, Rotterdam, the Netherlands
- ‡‡Cleveland Clinic Foundation, Cleveland, OH
- §§International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK
- ǁǁNew York-Presbyterian Hospital, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY
- ↵∗Address for Correspondence: David J. Cohen, MD, MSc, Saint-Luke’s Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, 4401 Wornall Road, Kansas City, Missouri 64111, Telephone: 816-932-4581, Fax: 816-932-4582.
Background The EXCEL trial compared outcomes in patients with unprotected left main coronary artery disease (LMCAD) treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) using everolimus-eluting stents. While rates of death, stroke, and myocardial infarction were similar at 36 months, event timing and repeat revascularization rates differed by treatment group.
Objectives To understand the effects of revascularization strategy from the patient’s perspective, we performed a prospective quality of life (QoL) sub-study alongside the EXCEL trial.
Methods Between September 2010 and March 2014, 1905 patients with LMCAD were randomized to undergo CABG or PCI, of whom 1788 participated in the QoL sub-study. QoL was assessed at baseline and 1, 12, and 36 months using the Seattle Angina Questionnaire, the SF-12, the Rose Dyspnea Scale, the Patient Health Questionnaire-8, and the EQ-5D. Differences between PCI and CABG were assessed using longitudinal random-effect growth curve models.
Results Over 36 months, both PCI and CABG were associated with significant improvements in QoL compared with baseline. At 1 month, PCI was associated with better QoL than CABG. By 12 months though, these differences were largely attenuated, and by 36 months, there were no significant QoL differences between PCI and CABG.
Conclusions Among selected patients with LMCAD, both PCI and CABG result in similar QoL improvement through 36 months, although a greater early benefit is seen with PCI. Taken together with the 3-year clinical results of EXCEL, these findings suggest that PCI and CABG provide similar intermediate-term outcomes for patients with LMCAD.
Funding: The EXCEL clinical trial (NCT01205776) and quality of life sub-study was funded by a research grant from Abbott Vascular.
Relationship with Industry:
Suzanne J. Baron: Edwards Lifesciences and St. Jude Medical (Consulting income)
Khaja Chinnakondepalli: none
Elizabeth A. Magnuson: Abbott Vascular, AstraZeneca, Boston Scientific, Daiichi-Sankyo, Edwards Lifesciences, Eli Lilly, Medtronic (Research grant support); Daiichi Sankyo (Consulting income)
David E. Kandzari: Abbott Vascular, St. Jude Medical, Biotronik, Boston Scientific, Medinol, Medtronic (Institutional research/grant support); Biotronik, Boston Scientific, Medtronic, Micell Technologies (Consulting income)
John Puskas: Scanlan Inc (Royalties)
Ori Ben-Yehuda: none
Gerrit-Anne van Es: none
David P. Taggart: none
Marie Claude-Morice: none
Nicholas J. Lembo: Abbott Vascular (Advisory board); Abbott Vascular, Boston Scientific, Medtronic (Speaker’s bureau).
W. Morris Brown III: none
Adrian Banning: Boston Scientific (Institutional educational grant); Medtronic, Abbott Vascular, Boston Scientific, Philips (Speaker’s bureau)
Charles A. Simonton: Abbott Vascular (employee)
A. Pieter Kappetein: Medtronic (employee)
Joseph F. Sabik: none
Patrick W. Serruys: Abbott Vascular, AstraZeneca Pharmaceuticals, Biotronik, Cardialysis B.V., GLG Research, Medtronic, Sinu Medical Sciences Technology Inc, Societe Europa Digital & Publishing, Stentys France, Svelte Medical Systems Inc., Volcano/Philips Europe, Q3 Medical Devices Limited, St. Jude Medical (Consulting income); Xeltis (Member CAB)
Gregg W. Stone: Reva Medical (Consulting income); Abbott Vascular (Royalty payments to employer, Columbia University, for sale of MitraClip) David J. Cohen: Abbott Vascular, Edwards Lifesciences, Medtronic, Boston Scientific (Research grant support); Edwards Lifesciences and Medtronic (Consulting income)
Clinical Trial Information: The EXCEL clinical trial is registered at clinicaltrials.gov as NCT01205776.
- Received September 15, 2017.
- Revision received October 5, 2017.
- Accepted October 17, 2017.