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Long-term PCI vs. CABG outcomes do not vary by acuity of presentation in left main disease
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Among patients with left main CAD undergoing revascularization, CABG and PCI had similar long-term outcomes, and the difference did not vary by whether patients had ACS or stable ischemic heart disease, according to findings presented in the American Heart Journal.
Serge Doucet, MD, and colleagues sought to determine whether the acuity of presentation had any effect on the outcomes of PCI vs. CABG in the EXCEL trial.
“Whether outcomes of CABG compared with PCI in patients with [left main] CAD and ACS differ from those with [stable ischemic heart disease] is unknown,” Doucet, the director of education in the department of medicine at the Montreal Heart Institute, and colleagues wrote. “As such, compelling evidence to inform how the acuity of presentation should guide decisions about revascularization is lacking.”
Doucet and colleagues analyzed 1,905 patients from the EXCEL study, of whom 60.7% presented with stable ischemic heart disease and 39.3% presented with ACS.
Acuity of presentation had no association with the primary endpoint of all-cause death, MI, or stroke at 3 years (multivariable adjusted HR = 0.94; 95% CI, 0.7-1.26), the researchers wrote.
PCI and CABG were similarly effective in terms of the primary endpoint regardless of whether patients presented with stable ischemic heart disease (aHR = 1.04; 95% CI, 0.73-1.48) or ACS (HR = 0.82; 95% CI, 0.54-1.26; P for interaction = .34), the researchers wrote.
“These findings may influence clinical practice by diminishing the primacy for immediate revascularization in patients with ACS who can be medically stabilized and by strengthening the role of the heart team in reaching optimal revascularization decision independent of clinical syndrome acuity,” Doucet and colleagues wrote. – by Earl Holland Jr.
Disclosures: The initial EXCEL trial was funded by Abbott. Doucet reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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