Bypass Surgery or Stenting for Left Main Coronary Artery Disease in Patients With Diabetes

Milan Milojevic, Patrick W. Serruys, Joseph F. Sabik, David E. Kandzari, Erick Schampaert, Ad J. van Boven, Ferenc Horkay, Imre Ungi, Samer Mansour, Adrian P. Banning, David P. Taggart, Manel Sabaté, Anthony H. Gershlick, Andrzej Bochenek, Jose Pomar, Nicholas J. Lembo, Nicolas Noiseux, John D. Puskas, Aaron Crowley, Ioanna Kosmidou & 7 others Roxana Mehran, Ori Ben-Yehuda, Philippe Genereux, Stuart J. Pocock, Charles A. Simonton, Gregg W. Stone, Arie Pieter Kappetein

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: The randomized EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial reported a similar rate of the 3-year composite primary endpoint of death, myocardial infarction (MI), or stroke in patients with left main coronary artery disease (LMCAD) and site-assessed low or intermediate SYNTAX scores treated with percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Whether these results are consistent in high-risk patients with diabetes, who have fared relatively better with CABG in most prior trials, is unknown. Objectives: In this pre-specified subgroup analysis from the EXCEL trial, the authors sought to examine the effect of diabetes in patients with LMCAD treated with PCI versus CABG. Methods: Patients (N = 1,905) with LMCAD and site-assessed low or intermediate CAD complexity (SYNTAX scores ≤32) were randomized 1:1 to PCI with everolimus-eluting stents versus CABG, stratified by the presence of diabetes. The primary endpoint was the rate of a composite of all-cause death, stroke, or MI at 3 years. Outcomes were examined in patients with (n = 554) and without (n = 1,350) diabetes. Results: The 3-year composite primary endpoint was significantly higher in diabetic compared with nondiabetic patients (20.0% vs. 12.9%; p < 0.001). The rate of the 3-year primary endpoint was similar after treatment with PCI and CABG in diabetic patients (20.7% vs. 19.3%, respectively; hazard ratio: 1.03; 95% confidence interval: 0.71 to 1.50; p = 0.87) and nondiabetic patients (12.9% vs. 12.9%, respectively; hazard ratio: 0.98; 95% confidence interval: 0.73 to 1.32; p = 0.89). All-cause death at 3 years occurred in 13.6% of PCI and 9.0% of CABG patients (p = 0.046), although no significant interaction was present between diabetes status and treatment for all-cause death (p = 0.22) or other endpoints, including the 3-year primary endpoint (p = 0.82) or the major secondary endpoints of death, MI, or stroke at 30 days (p = 0.61) or death, MI, stroke, or ischemia-driven revascularization at 3 years (p = 0.65). Conclusions: In the EXCEL trial, the relative 30-day and 3-year outcomes of PCI with everolimus-eluting stents versus CABG were consistent in diabetic and nondiabetic patients with LMCAD and site-assessed low or intermediate SYNTAX scores.(Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization [EXCEL]; NCT01205776)

Original languageEnglish (US)
Pages (from-to)1616-1628
Number of pages13
JournalJournal of the American College of Cardiology
Volume73
Issue number13
DOIs
StatePublished - Apr 9 2019

Fingerprint

Coronary Artery Bypass
Coronary Artery Disease
Percutaneous Coronary Intervention
Stroke
Myocardial Infarction
Cause of Death
Stents
Confidence Intervals
Myocardial Ischemia
Therapeutics

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Milojevic, M., Serruys, P. W., Sabik, J. F., Kandzari, D. E., Schampaert, E., van Boven, A. J., ... Kappetein, A. P. (2019). Bypass Surgery or Stenting for Left Main Coronary Artery Disease in Patients With Diabetes. Journal of the American College of Cardiology, 73(13), 1616-1628. https://doi.org/10.1016/j.jacc.2019.01.037
Milojevic, Milan ; Serruys, Patrick W. ; Sabik, Joseph F. ; Kandzari, David E. ; Schampaert, Erick ; van Boven, Ad J. ; Horkay, Ferenc ; Ungi, Imre ; Mansour, Samer ; Banning, Adrian P. ; Taggart, David P. ; Sabaté, Manel ; Gershlick, Anthony H. ; Bochenek, Andrzej ; Pomar, Jose ; Lembo, Nicholas J. ; Noiseux, Nicolas ; Puskas, John D. ; Crowley, Aaron ; Kosmidou, Ioanna ; Mehran, Roxana ; Ben-Yehuda, Ori ; Genereux, Philippe ; Pocock, Stuart J. ; Simonton, Charles A. ; Stone, Gregg W. ; Kappetein, Arie Pieter. / Bypass Surgery or Stenting for Left Main Coronary Artery Disease in Patients With Diabetes. In: Journal of the American College of Cardiology. 2019 ; Vol. 73, No. 13. pp. 1616-1628.
@article{f3e305eedeee4ab4a6b23ca40f2e8127,
title = "Bypass Surgery or Stenting for Left Main Coronary Artery Disease in Patients With Diabetes",
abstract = "Background: The randomized EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial reported a similar rate of the 3-year composite primary endpoint of death, myocardial infarction (MI), or stroke in patients with left main coronary artery disease (LMCAD) and site-assessed low or intermediate SYNTAX scores treated with percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Whether these results are consistent in high-risk patients with diabetes, who have fared relatively better with CABG in most prior trials, is unknown. Objectives: In this pre-specified subgroup analysis from the EXCEL trial, the authors sought to examine the effect of diabetes in patients with LMCAD treated with PCI versus CABG. Methods: Patients (N = 1,905) with LMCAD and site-assessed low or intermediate CAD complexity (SYNTAX scores ≤32) were randomized 1:1 to PCI with everolimus-eluting stents versus CABG, stratified by the presence of diabetes. The primary endpoint was the rate of a composite of all-cause death, stroke, or MI at 3 years. Outcomes were examined in patients with (n = 554) and without (n = 1,350) diabetes. Results: The 3-year composite primary endpoint was significantly higher in diabetic compared with nondiabetic patients (20.0{\%} vs. 12.9{\%}; p < 0.001). The rate of the 3-year primary endpoint was similar after treatment with PCI and CABG in diabetic patients (20.7{\%} vs. 19.3{\%}, respectively; hazard ratio: 1.03; 95{\%} confidence interval: 0.71 to 1.50; p = 0.87) and nondiabetic patients (12.9{\%} vs. 12.9{\%}, respectively; hazard ratio: 0.98; 95{\%} confidence interval: 0.73 to 1.32; p = 0.89). All-cause death at 3 years occurred in 13.6{\%} of PCI and 9.0{\%} of CABG patients (p = 0.046), although no significant interaction was present between diabetes status and treatment for all-cause death (p = 0.22) or other endpoints, including the 3-year primary endpoint (p = 0.82) or the major secondary endpoints of death, MI, or stroke at 30 days (p = 0.61) or death, MI, stroke, or ischemia-driven revascularization at 3 years (p = 0.65). Conclusions: In the EXCEL trial, the relative 30-day and 3-year outcomes of PCI with everolimus-eluting stents versus CABG were consistent in diabetic and nondiabetic patients with LMCAD and site-assessed low or intermediate SYNTAX scores.(Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization [EXCEL]; NCT01205776)",
author = "Milan Milojevic and Serruys, {Patrick W.} and Sabik, {Joseph F.} and Kandzari, {David E.} and Erick Schampaert and {van Boven}, {Ad J.} and Ferenc Horkay and Imre Ungi and Samer Mansour and Banning, {Adrian P.} and Taggart, {David P.} and Manel Sabat{\'e} and Gershlick, {Anthony H.} and Andrzej Bochenek and Jose Pomar and Lembo, {Nicholas J.} and Nicolas Noiseux and Puskas, {John D.} and Aaron Crowley and Ioanna Kosmidou and Roxana Mehran and Ori Ben-Yehuda and Philippe Genereux and Pocock, {Stuart J.} and Simonton, {Charles A.} and Stone, {Gregg W.} and Kappetein, {Arie Pieter}",
year = "2019",
month = "4",
day = "9",
doi = "10.1016/j.jacc.2019.01.037",
language = "English (US)",
volume = "73",
pages = "1616--1628",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "13",

}

Milojevic, M, Serruys, PW, Sabik, JF, Kandzari, DE, Schampaert, E, van Boven, AJ, Horkay, F, Ungi, I, Mansour, S, Banning, AP, Taggart, DP, Sabaté, M, Gershlick, AH, Bochenek, A, Pomar, J, Lembo, NJ, Noiseux, N, Puskas, JD, Crowley, A, Kosmidou, I, Mehran, R, Ben-Yehuda, O, Genereux, P, Pocock, SJ, Simonton, CA, Stone, GW & Kappetein, AP 2019, 'Bypass Surgery or Stenting for Left Main Coronary Artery Disease in Patients With Diabetes', Journal of the American College of Cardiology, vol. 73, no. 13, pp. 1616-1628. https://doi.org/10.1016/j.jacc.2019.01.037

Bypass Surgery or Stenting for Left Main Coronary Artery Disease in Patients With Diabetes. / Milojevic, Milan; Serruys, Patrick W.; Sabik, Joseph F.; Kandzari, David E.; Schampaert, Erick; van Boven, Ad J.; Horkay, Ferenc; Ungi, Imre; Mansour, Samer; Banning, Adrian P.; Taggart, David P.; Sabaté, Manel; Gershlick, Anthony H.; Bochenek, Andrzej; Pomar, Jose; Lembo, Nicholas J.; Noiseux, Nicolas; Puskas, John D.; Crowley, Aaron; Kosmidou, Ioanna; Mehran, Roxana; Ben-Yehuda, Ori; Genereux, Philippe; Pocock, Stuart J.; Simonton, Charles A.; Stone, Gregg W.; Kappetein, Arie Pieter.

In: Journal of the American College of Cardiology, Vol. 73, No. 13, 09.04.2019, p. 1616-1628.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Bypass Surgery or Stenting for Left Main Coronary Artery Disease in Patients With Diabetes

AU - Milojevic, Milan

AU - Serruys, Patrick W.

AU - Sabik, Joseph F.

AU - Kandzari, David E.

AU - Schampaert, Erick

AU - van Boven, Ad J.

AU - Horkay, Ferenc

AU - Ungi, Imre

AU - Mansour, Samer

AU - Banning, Adrian P.

AU - Taggart, David P.

AU - Sabaté, Manel

AU - Gershlick, Anthony H.

AU - Bochenek, Andrzej

AU - Pomar, Jose

AU - Lembo, Nicholas J.

AU - Noiseux, Nicolas

AU - Puskas, John D.

AU - Crowley, Aaron

AU - Kosmidou, Ioanna

AU - Mehran, Roxana

AU - Ben-Yehuda, Ori

AU - Genereux, Philippe

AU - Pocock, Stuart J.

AU - Simonton, Charles A.

AU - Stone, Gregg W.

AU - Kappetein, Arie Pieter

PY - 2019/4/9

Y1 - 2019/4/9

N2 - Background: The randomized EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial reported a similar rate of the 3-year composite primary endpoint of death, myocardial infarction (MI), or stroke in patients with left main coronary artery disease (LMCAD) and site-assessed low or intermediate SYNTAX scores treated with percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Whether these results are consistent in high-risk patients with diabetes, who have fared relatively better with CABG in most prior trials, is unknown. Objectives: In this pre-specified subgroup analysis from the EXCEL trial, the authors sought to examine the effect of diabetes in patients with LMCAD treated with PCI versus CABG. Methods: Patients (N = 1,905) with LMCAD and site-assessed low or intermediate CAD complexity (SYNTAX scores ≤32) were randomized 1:1 to PCI with everolimus-eluting stents versus CABG, stratified by the presence of diabetes. The primary endpoint was the rate of a composite of all-cause death, stroke, or MI at 3 years. Outcomes were examined in patients with (n = 554) and without (n = 1,350) diabetes. Results: The 3-year composite primary endpoint was significantly higher in diabetic compared with nondiabetic patients (20.0% vs. 12.9%; p < 0.001). The rate of the 3-year primary endpoint was similar after treatment with PCI and CABG in diabetic patients (20.7% vs. 19.3%, respectively; hazard ratio: 1.03; 95% confidence interval: 0.71 to 1.50; p = 0.87) and nondiabetic patients (12.9% vs. 12.9%, respectively; hazard ratio: 0.98; 95% confidence interval: 0.73 to 1.32; p = 0.89). All-cause death at 3 years occurred in 13.6% of PCI and 9.0% of CABG patients (p = 0.046), although no significant interaction was present between diabetes status and treatment for all-cause death (p = 0.22) or other endpoints, including the 3-year primary endpoint (p = 0.82) or the major secondary endpoints of death, MI, or stroke at 30 days (p = 0.61) or death, MI, stroke, or ischemia-driven revascularization at 3 years (p = 0.65). Conclusions: In the EXCEL trial, the relative 30-day and 3-year outcomes of PCI with everolimus-eluting stents versus CABG were consistent in diabetic and nondiabetic patients with LMCAD and site-assessed low or intermediate SYNTAX scores.(Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization [EXCEL]; NCT01205776)

AB - Background: The randomized EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial reported a similar rate of the 3-year composite primary endpoint of death, myocardial infarction (MI), or stroke in patients with left main coronary artery disease (LMCAD) and site-assessed low or intermediate SYNTAX scores treated with percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Whether these results are consistent in high-risk patients with diabetes, who have fared relatively better with CABG in most prior trials, is unknown. Objectives: In this pre-specified subgroup analysis from the EXCEL trial, the authors sought to examine the effect of diabetes in patients with LMCAD treated with PCI versus CABG. Methods: Patients (N = 1,905) with LMCAD and site-assessed low or intermediate CAD complexity (SYNTAX scores ≤32) were randomized 1:1 to PCI with everolimus-eluting stents versus CABG, stratified by the presence of diabetes. The primary endpoint was the rate of a composite of all-cause death, stroke, or MI at 3 years. Outcomes were examined in patients with (n = 554) and without (n = 1,350) diabetes. Results: The 3-year composite primary endpoint was significantly higher in diabetic compared with nondiabetic patients (20.0% vs. 12.9%; p < 0.001). The rate of the 3-year primary endpoint was similar after treatment with PCI and CABG in diabetic patients (20.7% vs. 19.3%, respectively; hazard ratio: 1.03; 95% confidence interval: 0.71 to 1.50; p = 0.87) and nondiabetic patients (12.9% vs. 12.9%, respectively; hazard ratio: 0.98; 95% confidence interval: 0.73 to 1.32; p = 0.89). All-cause death at 3 years occurred in 13.6% of PCI and 9.0% of CABG patients (p = 0.046), although no significant interaction was present between diabetes status and treatment for all-cause death (p = 0.22) or other endpoints, including the 3-year primary endpoint (p = 0.82) or the major secondary endpoints of death, MI, or stroke at 30 days (p = 0.61) or death, MI, stroke, or ischemia-driven revascularization at 3 years (p = 0.65). Conclusions: In the EXCEL trial, the relative 30-day and 3-year outcomes of PCI with everolimus-eluting stents versus CABG were consistent in diabetic and nondiabetic patients with LMCAD and site-assessed low or intermediate SYNTAX scores.(Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization [EXCEL]; NCT01205776)

UR - http://www.scopus.com/inward/record.url?scp=85063343264&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85063343264&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2019.01.037

DO - 10.1016/j.jacc.2019.01.037

M3 - Article

VL - 73

SP - 1616

EP - 1628

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 13

ER -