Xin Huang1,2, Björn Redfors1,3, Shmuel Chen1, Yangbo Liu1, Ori Ben-Yehuda1,4, John D Puskas5, David E Kandzari6, Béla Merkely7, Ferenc Horkay8, Ad J van Boven9, Piet W Boonstra9, Joseph F Sabik10, Patrick W Serruys11, Arie Pieter Kappetein12, Gregg W Stone1,4. 1. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA. 2. Division of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China. 3. Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden. 4. Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA. 5. Mount Sinai Heart at Mount Sinai Saint Luke's, New York, NY, USA. 6. Piedmont Heart Institute, Atlanta, GA, USA. 7. Heart and Vascular Center, Semmelweis University, Budapest, Hungary. 8. National Institute of Cardiology, Budapest, Hungary. 9. Medisch Centrum Leeuwarden, Leeuwarden, Netherlands. 10. Department of Surgery, UH Cleveland Medical Center, Cleveland, OH, USA. 11. Imperial College of Science, Technology and Medicine, London, UK. 12. Thoraxcenter, Erasmus MC, Rotterdam, Netherlands.
Abstract
OBJECTIVES:Percutaneous coronary intervention (PCI) is often favoured over coronary artery bypass grafting (CABG) surgery for revascularization in patients with chronic obstructive pulmonary disease (COPD). We studied whether COPD affected clinical outcomes according to revascularization in the Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial, in which PCI with everolimus-eluting stents was non-inferior to CABG for the treatment of patients with left main coronary artery disease and low or intermediate SYNTAX scores. METHODS: Patients with a history of COPD were propensity score matched to those without COPD. Outcomes at 30 days and 3 years in both groups were compared in patients randomized to PCI versus CABG. RESULTS:COPD status was available for 1901 of 1905 randomized patients (99.8%), 148 of whom had COPD (7.8%). Propensity score matching yielded 135 patients with COPD and 675 patients without COPD. Patients with COPD had higher 3-year rates of the primary composite end point of death, myocardial infarction or stroke (31.7% vs 14.5%, P < 0.0001), death (17.1% vs 7.5%, P = 0.0005) and myocardial infarction (18.3% vs 7.3%, P < 0.0001), but not stroke (3.3% vs 2.9%, P = 0.84). There were no statistically significant interactions in the relative risks of PCI versus CABG for the primary composite end point in patients with and without COPD at 30 days [hazard ratio (HR) 0.39, 95% confidence interval (CI) 0.12-1.21 vs HR 0.55, 95% CI 0.29-1.06; Pinteraction = 0.61] or at 3 years (HR 0.85, 95% CI 0.46-1.56 vs HR 1.28, 95% CI 0.84-1.94; Pinteraction = 0.27). CONCLUSIONS: In the EXCEL trial, COPD was independently associated with poor prognosis after left main coronary artery disease revascularization. The relative risks of PCI versus CABG at 30 days and 3 years were consistent in patients with and without COPD. CLINICAL TRIAL REGISTRATION NUMBER: http://www.clinicaltrials.gov; NCT01205776.
RCT Entities:
OBJECTIVES: Percutaneous coronary intervention (PCI) is often favoured over coronary artery bypass grafting (CABG) surgery for revascularization in patients with chronic obstructive pulmonary disease (COPD). We studied whether COPD affected clinical outcomes according to revascularization in the Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial, in which PCI with everolimus-eluting stents was non-inferior to CABG for the treatment of patients with left main coronary artery disease and low or intermediate SYNTAX scores. METHODS:Patients with a history of COPD were propensity score matched to those without COPD. Outcomes at 30 days and 3 years in both groups were compared in patients randomized to PCI versus CABG. RESULTS:COPD status was available for 1901 of 1905 randomized patients (99.8%), 148 of whom had COPD (7.8%). Propensity score matching yielded 135 patients with COPD and 675 patients without COPD. Patients with COPD had higher 3-year rates of the primary composite end point of death, myocardial infarction or stroke (31.7% vs 14.5%, P < 0.0001), death (17.1% vs 7.5%, P = 0.0005) and myocardial infarction (18.3% vs 7.3%, P < 0.0001), but not stroke (3.3% vs 2.9%, P = 0.84). There were no statistically significant interactions in the relative risks of PCI versus CABG for the primary composite end point in patients with and without COPD at 30 days [hazard ratio (HR) 0.39, 95% confidence interval (CI) 0.12-1.21 vs HR 0.55, 95% CI 0.29-1.06; Pinteraction = 0.61] or at 3 years (HR 0.85, 95% CI 0.46-1.56 vs HR 1.28, 95% CI 0.84-1.94; Pinteraction = 0.27). CONCLUSIONS: In the EXCEL trial, COPD was independently associated with poor prognosis after left main coronary artery disease revascularization. The relative risks of PCI versus CABG at 30 days and 3 years were consistent in patients with and without COPD. CLINICAL TRIAL REGISTRATION NUMBER: http://www.clinicaltrials.gov; NCT01205776.
Authors: Rutao Wang; Mariusz Tomaniak; Kuniaki Takahashi; Chao Gao; Hideyuki Kawashima; Hironori Hara; Masafumi Ono; David van Klaveren; Robert-Jan van Geuns; Marie-Claude Morice; Piroze M Davierwala; Michael J Mack; Adam Witkowski; Nick Curzen; Sergio Berti; Francesco Burzotta; Stefan James; Arie Pieter Kappetein; Stuart J Head; Daniel J F M Thuijs; Friedrich W Mohr; David R Holmes; Ling Tao; Yoshinobu Onuma; Patrick W Serruys Journal: Clin Res Cardiol Date: 2021-03-12 Impact factor: 5.460
Authors: Zoltan Ruzsa; Rafał Januszek; Viktor Óriás; Michał Chyrchel; Joanna Wojtasik-Bakalarz; Jerzy Bartuś; Saleh Arif; Paweł Kleczyński; Tomasz Tokarek; Andras Nyerges; Agata Stanek; Dariusz Dudek; Stanisław Bartuś Journal: Ann Transl Med Date: 2020-03