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Stenting Left Main

Abstract

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Long-Term Outcomes After PCI or CABG for Left Main Coronary Artery Disease According to Lesion Location Revascularization in Patients With Left Main Coronary Artery Disease and Left Ventricular Dysfunction Restricted access Mortality After Repeat Revascularization Following PCI or CABG for Left Main Disease: The EXCEL Trial Predictors of Left Main Coronary Artery Disease in the ISCHEMIA Trial Intravascular Imaging and 12-Month Mortality After Unprotected Left Main Stem PCI: An Analysis From the British Cardiovascular Intervention Society Database Impact of Staging Percutaneous Coronary Intervention in Left Main Artery Disease: Insights From the EXCEL Trial Impact of Lesion Preparation Strategies on Outcomes of Left Main PCI: The EXCEL Trial Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis
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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 3‐year MACE; all‐cause 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 3‐year rates of MACE (from RA to DIR: 17.9%, 20.2%, 14.5%, 14.7%; p = .50) or ischemia‐driven revascularization (from RA to DIR: 16.8%, 10.8%, 12.3%, 14.2%; p = .65). The adjusted 3‐year rates of MACE did not differ according to LPS.

 

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

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