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IVUS Guidance

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Intravascular ultrasound assessment of the effects of rotational atherectomy in calcified coronary artery lesions Effects of Intravascular Ultrasound-Guided Versus Angiography-Guided New-Generation Drug-Eluting Stent Implantation: Meta-Analysis With Individual Patient-Level Data From 2,345 Randomized Patients Comparison of paclitaxel-eluting stents (Taxus) and everolimus-eluting stents (Xience) in left main coronary artery disease with 3 years follow-up (from the ESTROFA-LM registry) Intravascular ultrasound-derived minimal lumen area criteria for functionally significant left main coronary artery stenosis Defining a new standard for IVUS optimized drug eluting stent implantation: the PRAVIO study Intravascular Ultrasound Parameters Associated With Stent Thrombosis After Drug-Eluting Stent Deployment Impact of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention on Long-Term Clinical Outcomes in Patients Undergoing Complex Procedures Contribution of stent underexpansion to recurrence after sirolimus-eluting stent implantation for in-stent restenosis Intravascular Ultrasound-Derived Virtual Fractional Flow Reserve for the Assessment of Myocardial Ischemia Long-term survival in patients undergoing percutaneous interventions with or without intracoronary pressure wire guidance or intracoronary ultrasonographic imaging: a large cohort study

Original Research2018 Dec 27. [Epub ahead of print]

JOURNAL:Eur J Cardiothorac Surg. Article Link

Impact of chronic obstructive pulmonary disease on prognosis after percutaneous coronary intervention and bypass surgery for left main coronary artery disease: an analysis from the EXCEL trial

Huang X, Redfors B, Stone GW et al. Keywords: EXCEL trial; COPD; PCI vs CABG; outcome

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.