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January 15, 2020

Three-Year Findings Published for Mortality of Repeat Revascularizations in the EXCEL Trial

January 15, 2020—The 3-year findings from an investigation to determine the incidence and impact on mortality of repeat revascularization after index percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD) in the EXCEL trial were published by Gennaro Giustino, MD, et al in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions.

This analysis from the EXCEL trial included all patients with LMCAD and site-assessed low or intermediate SYNTAX scores randomized to PCI (n = 948) or CABG (n = 957). An independent clinical events committee adjudicated repeat revascularization events. The effect of repeat revascularization on mortality through 3-year follow-up was examined in time-varying Cox regression models.

As summarized in JACC: Cardiovascular Interventions, there were 346 repeat revascularization procedures among 185 patients during 3-year follow-up. The EXCEL investigators reported the following:

  • PCI was associated with higher rates of any repeat revascularization (12.9% vs 7.6%; hazard ratio [HR], 1.73; 95% confidence interval [CI], 1.28–2.33; P = .0003).
  • The need for repeat revascularization was independently associated with an increased risk for 3-year all-cause mortality (adjusted HR, 2.05; 95% CI, 1.13–3.7; P = .02) and cardiovascular mortality (adjusted HR, 4.22; 95% CI, 2.10–8.48; P < .0001) consistently after both PCI and CABG (Pint = .85 for both endpoints).
  • Although target vessel revascularization and target lesion revascularization were both associated with an increased risk for mortality, target vessel non–target lesion revascularization and non–target vessel revascularization were not.

The EXCEL trial showed that repeat revascularization during follow-up was performed less frequently after CABG than PCI and was associated with increased mortality after both procedures. Reducing the need for repeat revascularization may further improve long-term survival after percutaneous or surgical treatment of LMCAD, concluded the investigators in JACC: Cardiovascular Interventions.

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