Outcomes of patients with and without baseline lipid-lowering therapy undergoing revascularization for left main coronary artery disease: analysis from the EXCEL trial
2019
Objectives There is a paucity of data on the effect of
baseline lipid-lowering therapy (LLT) in patients undergoing
revascularization for left main (LM) coronary artery disease
(CAD). We compared outcomes for patients with LMCAD
randomized to percutaneous coronary intervention (PCI) or
coronary artery bypass grafting (CABG) according to the
presence of baseline LLT in the EXCEL trial.
Patients and methods The EXCEL trial randomized 1905
patients with LMCAD and SYNTAX scores up to 32 to PCI
with everolimus-eluting stents versus CABG. Patients were
categorized according to whether they were medically
treated with LLT at baseline, and their outcomes were
examined using multivariable Cox proportional hazards
regression. The primary endpoint was a composite of death,
stroke, or myocardial infarction at 3 years.
Results Among 1901 patients with known baseline LLT
status, 1331 (70.0%) were medically treated with LLT at
baseline. There were no significant differences between the
PCI and CABG groups in the 3-year rates of the primary
endpoint in patients with versus without baseline LLT
(Pinteraction = 0.62). Among patients with baseline LLT, the
3-year rate of ischemia-driven revascularization was higher
after PCI compared with CABG (13.7 vs. 5.3%; adjusted
hazard ratio = 2.97; 95% confidence interval: 1.95–4.55;
P < 0.0001), in contrast to patients without baseline LLT
(9.8 vs. 12.1%; adjusted hazard ratio = 0.79; 95% confidence
interval: 0.47–1.33; P = 0.39) (Pinteraction = 0.0003).
Conclusion In the EXCEL trial, 3-year major adverse event
rates after PCI versus CABG for LMCAD were similar and
consistent in patients with and without LLT at baseline;
however, revascularization during follow-up was more
common after PCI compared with CABG in patients with
baseline LLT, but not in those without baseline LLT. Coron
Artery Dis 30:143–149 Copyright © 2019 Wolters Kluwer
Health, Inc. All rights reserved.
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