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Stroke Rates Following Surgical Versus Percutaneous Coronary Revascularization Sex differences in left main coronary artery stenting: Different characteristics but similar outcomes for women compared with men Long-Term Outcomes After PCI or CABG for Left Main Coronary Artery Disease According to Lesion Location Clinical and angiographic outcomes of patients treated with everolimus-eluting stents or first-generation Paclitaxel-eluting stents for unprotected left main disease Complex PCI procedures: challenges for the interventional cardiologist Percutaneous Coronary Intervention Using Drug-Eluting Stents Versus Coronary Artery Bypass Grafting for Unprotected Left Main Coronary Artery Stenosis: A Meta-Analysis of Randomized Trials Clinical Outcome After DK Crush Versus Culotte Stenting of Distal Left Main Bifurcation Lesions: The 3-Year Follow-Up Results of the DKCRUSH-III Study Expansion or contraction of stenting in coronary artery disease? Revascularization in Patients With Left Main Coronary Artery Disease and Left Ventricular Dysfunction Left Main Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Prior Cerebrovascular Disease: Results From the EXCEL Trial

Clinical Trial2020 Jun 27.

JOURNAL:Catheter Cardiovasc Interv . Article Link

Impact of Lesion Preparation Strategies on Outcomes of Left Main PCI: The EXCEL Trial

N Beohar, S Chen, GW Stone et al. Keywords: lesion preparation left main coronary artery; PCI

ABSTRACT

OBJECTIVES - We examined outcomes according to lesion preparation strategy (LPS) in patients with left main coronary artery (LMCA) percutaneous coronary intervention (PCI) in the EXCEL trial.

 

BACKGROUND - The optimal LPS for LMCA PCI is unclear.

 

METHODS - We categorized LPS hierarchically (high to low) as: (a) rotational atherectomy (RA); (b) cutting or scoring balloon (CSB); (c) balloon angioplasty (BAL); and d) direct stenting (DIR). The primary endpoint was 3year MACE; allcause death, stroke, or myocardial infarction.

 

RESULTS - Among 938 patients undergoing LMCA PCI, RA was performed in 6.0%, CSB 9.5%, BAL 71.3%, and DIR 13.2%. In patients treated with DIR, BAL, CSB, and RA, respectively, there was a progressive increase in SYNTAX score, LMCA complex bifurcation, trifurcation or calcification, number of stents, and total stent length. Any procedural complication occurred in 10.4% of cases overall, with the lowest rate in the DIR (7.4%) and highest in the RA group (16.1%) (p trend = .22). There were no significant differences in the 3year rates of MACE (from RA to DIR: 17.9%, 20.2%, 14.5%, 14.7%; p = .50) or ischemiadriven revascularization (from RA to DIR: 16.8%, 10.8%, 12.3%, 14.2%; p = .65). The adjusted 3year rates of MACE did not differ according to LPS.

 

CONCLUSIONS - The comparable 3year outcomes suggest that appropriate lesion preparation may be able to overcome the increased risks of complex LMCA lesion morphology.