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Do EXCEL and NOBLE translate into real world? A 5-year observational study of left main stem outcomes

George Joy1, Hany Eissa2

  • 1Cardiology, Barts Health NHS Trust, London, UK g.joy@nhs.net.

Open Heart
|October 30, 2020
PubMed

Insights

Medical management of left mainstem (LMS) disease yields poor outcomes. Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) show comparable results, with PCI viable for selected LMS patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • Left mainstem (LMS) disease is a critical condition requiring careful management.
  • Treatment options include percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), and medical management.
  • Real-world outcomes of these strategies need continuous evaluation.

Purpose of the Study:

  • To evaluate the 5-year real-world outcomes of patients with significant left mainstem (LMS) disease.
  • To compare outcomes between PCI, CABG, and medical management for LMS disease.
  • To identify optimal treatment strategies for LMS disease.

Main Methods:

  • Retrospective analysis of 119 patients with LMS disease identified in 2012.
  • Comparison of baseline characteristics and 5-year outcomes.
  • Assessment of major adverse cardiovascular events (MACE), including stroke, myocardial infarction (MI), target vessel revascularisation, and all-cause mortality.

Main Results:

  • CABG was performed in 62%, PCI in 12%, and medical management in 26% of patients.
  • PCI patients had higher rates of pre-treatment heart failure compared to CABG patients.
  • Medical management was associated with significantly higher MACE (74% vs 25%) and all-cause mortality (52% vs 19%) compared to revascularisation (PCI or CABG).

Conclusions:

  • Medical management of LMS disease is associated with poor outcomes, consistent with historical data.
  • PCI remains a viable option for selected patients with LMS disease.
  • Revascularisation strategies (PCI or CABG) offer superior outcomes compared to medical management for LMS disease.
Abstract

Keywords:
coronary artery diseasecoronary intervention (PCI)surgery-coronary bypass

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