Validating the EXCEL Hypothesis: A Propensity Score Matched 3-Year Comparison of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Graft in Left Main Patients With SYNTAX Score ≤ 32

被引:22
作者
Capodanno, Davide [1 ,2 ]
Caggegi, Anna [1 ]
Capranzano, Piera [1 ,2 ]
Cincotta, Glauco [1 ]
Miano, Marco [1 ]
Barrano, Gionbattista [1 ]
Monaco, Sergio [1 ]
Calvo, Francesco [1 ]
Tamburino, Corrado [1 ,2 ]
机构
[1] Ferrarotto Hosp, Cardiovasc Dept, Catania, Italy
[2] ETNA Fdn, Catania, Italy
关键词
EXCEL; left main; percutaneous coronary intervention; ELUTING STENTS; DISEASE; OUTCOMES; REGISTRY;
D O I
10.1002/ccd.22992
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives: The aim of this study is to verify the study hypothesis of the EXCEL trial by comparing percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) in an EXCEL-like population of patients. Background: The upcoming EXCEL trial will test the hypothesis that left main patients with SYNTAX score <= 32 experience similar rates of 3-year death, myocardial infarction (MI), or cerebrovascular accidents (CVA) following revascularization by PCI or CABG. Methods: We compared the 3-year rates of death/MI/CVA and death/MI/CVA/target vessel revascularization (MACCE) in 556 patients with left main disease and SYNTAX score <= 32 undergoing PCI (n = 285) or CABG (n = 271). To account for confounders, outcome parameters underwent extensive statistical adjustment. Results: The unadjusted incidence of death/MI/CVA was similar between PCI and CABG (12.7% vs. 8.4%, P = 0.892), while MACCE were higher in the PCI group compared to the CABG group (27.0% vs. 11.8%, P < 0.001). After propensity score matching, PCI was not associated with a significant increase in the rate of death/MI/CVA (11.8% vs. 10.7%, P = 0.948), while MACCE were more frequently noted among patients treated with PCI (28.8% vs. 14.1%, P = 0.002). Adjustment by means of SYNTAX score and EUROSCORE, covariates with and without propensity score, and propensity score alone did not change significantly these findings. Conclusions: In an EXCEL-like cohort of patients with left main disease, there seems to be a clinical equipoise between PCI and CABG in terms of death/MI/CVA. However, even in patients with SYNTAX score <= 32, CABG is superior to PCI when target vessel revascularization is included in the combined endpoint. (C) 2011 Wiley-Liss, Inc.
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收藏
页码:936 / 943
页数:8
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