Impact of lesion preparation strategies on outcomes of left main PCI: The EXCEL trial

Nirat Beohar*, Shmuel Chen, Nicholas J. Lembo, Adrian P. Banning, Patrick W. Serruys, Martin B. Leon, Marie Claude Morice, Philippe Généreux, David E. Kandzari, Arie Pieter Kappetein, Joseph F. Sabik, Ovidiu Dressler, Thomas McAndrew, Zixuan Zhang, Gregg W. Stone

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

7 Citations (Scopus)


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%) (ptrend =.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.

Original languageEnglish
Pages (from-to)24-32
Number of pages9
JournalCatheterization and Cardiovascular Interventions
Issue number1
Publication statusPublished - 27 Jun 2020

Bibliographical note

Funding information: Abbott Vascular

Publisher Copyright:
© 2020 Wiley Periodicals LLC.


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