Suzanne J Baron1, Khaja Chinnakondepalli1, Elizabeth A Magnuson1, David E Kandzari2, John D Puskas3, Ori Ben-Yehuda4, Gerrit-Anne van Es5, David P Taggart6, Marie-Claude Morice7, Nicholas J Lembo3, W Morris Brown3, Adrian Banning6, Charles A Simonton8, A Pieter Kappetein9, Joseph F Sabik10, Patrick W Serruys11, Gregg W Stone12, David J Cohen13. 1. Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri. 2. Piedmont Heart Institute, Atlanta, Georgia. 3. Mount Sinai Medical Center, New York, New York. 4. Cardiovascular Research Foundation, New York, New York. 5. Cardialysis, Rotterdam, the Netherlands. 6. Oxford University Hospitals, Oxford, United Kingdom. 7. Ramsay Générale de Santé, Hospital Privé Jacques Cartier, Massy, France. 8. Abbott Vascular Inc., Abbott Park, Illinois. 9. Erasmus Medical Center, Rotterdam, the Netherlands. 10. Cleveland Clinic Foundation, Cleveland, Ohio. 11. International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom. 12. Cardiovascular Research Foundation, New York, New York; New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York. 13. Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri. Electronic address: dcohen@saint-lukes.org.
Abstract
BACKGROUND: The EXCEL (Evaluation of Xience Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial compared outcomes in patients with unprotected left main coronary artery disease (LMCAD) treated with coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) using everolimus-eluting stents. Whereas 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, a prospective quality of life (QoL) substudy was performed alongside the EXCEL trial. METHODS:Between September 2010 and March 2014, 1,905 patients with LMCAD were randomized to undergo CABG or PCI, of whom 1,788 participated in the QoL substudy. QoL was assessed at baseline and 1, 12, and 36 months using the Seattle Angina Questionnaire, the 12-Item Short Form Health Survey, 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. (Evaluation of Xience Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization [EXCEL]; NCT01205776).
RCT Entities:
BACKGROUND: The EXCEL (Evaluation of Xience Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial compared outcomes in patients with unprotected left main coronary artery disease (LMCAD) treated with coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) using everolimus-eluting stents. Whereas 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, a prospective quality of life (QoL) substudy was performed alongside the EXCEL trial. METHODS: Between September 2010 and March 2014, 1,905 patients with LMCAD were randomized to undergo CABG or PCI, of whom 1,788 participated in the QoL substudy. QoL was assessed at baseline and 1, 12, and 36 months using the Seattle Angina Questionnaire, the 12-Item Short Form Health Survey, 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. (Evaluation of Xience Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization [EXCEL]; NCT01205776).
Authors: Michael Wester; Franziska Koll; Mark Luedde; Christoph Langer; Markus Resch; Andreas Luchner; Karolina Müller; Florian Zeman; Michael Koller; Lars S Maier; Samuel Sossalla Journal: Clin Res Cardiol Date: 2022-09-13 Impact factor: 6.138
Authors: Ruth Masterson Creber; Arnaldo Dimagli; Cristiano Spadaccio; Annie Myers; Marco Moscarelli; Michelle Demetres; Matthew Little; Stephen Fremes; Mario Gaudino Journal: Eur Heart J Qual Care Clin Outcomes Date: 2022-05-05
Authors: Qin Fan; Jun Liu; Yan Xu; Ruiqing Ni; Rui Xi; Fang Wang; Jian Hu; Hongyue Sun; Zhenkun Yang; Mi Zhou; Ruiyan Zhang; Qiang Zhao; Rong Tao Journal: Front Cardiovasc Med Date: 2021-06-24