Comparing results of bypass surgery and percutaneous coronary intervention for left main disease by surgical revascularization pump strategy

Craig M. Jarrett, Marc Pelletier, Yasir Abu-Omar, Cristian Baeza, Yakov Elgudin, Alan Markowitz, Zhipeng Zhou, Björn Redfors, Ovidiu Dressler, Arie Pieter Kappetein, Patrick W. Serruys, Gregg W. Stone, Joseph F. Sabik*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

21 Downloads (Pure)

Abstract

Objective: 

We performed a post hoc analysis of the Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial to determine the effect an on-versus off-pump strategy had on outcomes when compared with percutaneous coronary intervention. 

Methods:

All randomized patients in EXCEL (n = 1905) were included. The outcomes of interest were the primary end point composite of death from any cause, stroke, or myocardial infarction; the composite study end point or ischemia-driven revascularization; and the rate of death from any cause at 5 years. Event rates were based on Kaplan–Meier estimates in time-to-first-event analyses. 

Results: 

Propensity matching resulted in groups of 1142 patients (571 each) for on-pump coronary artery bypass grafting versus percutaneous coronary intervention and 472 patients (236 each) for off-pump coronary artery bypass grafting versus percutaneous coronary intervention. In the on-pump coronary artery bypass grafting versus percutaneous coronary intervention matched groups, the composite end point was similar (18.0% vs 22.1%, P = .19) and the composite end point or ischemia-driven revascularization (23.3% vs 31.0%, P = .01) was lower, and mortality (7.6% vs 11.8%, P = .025) was lower in the on-pump coronary artery bypass grafting group at 5 years. In the off-pump coronary artery bypass grafting versus percutaneous coronary intervention matched groups, the composite end point (19.4% vs 22.2%, P = .47), composite end point or ischemia-driven revascularization (25.9% vs 34.2%, P = .07), and mortality (12.5% vs 14.2%, P = .59) were similar at 5 years. 

Conclusions: 

In the EXCEL trial, on-pump coronary artery bypass grafting was associated with a decreased 5-year rate of the composite outcome of death, stroke, myocardial infarction, or ischemia-driven revascularization, and decreased mortality when compared with percutaneous coronary intervention, whereas outcomes of off-pump coronary artery bypass grafting were similar to percutaneous coronary intervention.

Original languageEnglish
Pages (from-to)372-388
Number of pages17
JournalJTCVS Open
Volume16
Early online date3 Jul 2023
DOIs
Publication statusPublished - Dec 2023

Bibliographical note

Publisher Copyright:
© 2023

Fingerprint

Dive into the research topics of 'Comparing results of bypass surgery and percutaneous coronary intervention for left main disease by surgical revascularization pump strategy'. Together they form a unique fingerprint.

Cite this