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Impact of chronic obstructive pulmonary disease on prognosis after percutaneous coronary intervention and bypass surgery for left main coronary artery disease: An analysis from the EXCEL trial

Journal article
Authors Huang Xin
Björn Redfors
Shmuel Chen
Yangbo Liu
Ori Ben-Yehuda
John D. Puskas
David E. Kandzari
Bcrossed D.Signla Merkely
Ferenc Horkay
Ad J. Van Boven
Piet W. Boonstra
Joseph F. Sabik
Patrick W. Serruys
Arie Pieter Kappetein
Gregg W. Stone
Published in European Journal of Cardio-thoracic Surgery
Volume 55
Issue 6
Pages 1144-1151
ISSN 1010-7940
Publication year 2019
Published at Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 1144-1151
Language en
Keywords Chronic obstructive pulmonary disease, Coronary artery bypass grafting, Left main coronary artery disease, Percutaneous coronary intervention
Subject categories Cardiac and Cardiovascular Systems, Thoracic surgery


Percutaneous coronary intervention (PCI) is often favoured over coronary artery bypass grafting (CABG) surgery for revascularization in patients with chronic obstructive pulmonary disease (COPD). We studied whether COPD affected clinical outcomes according to revascularization in the Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial, in which PCI with everolimus-eluting stents was non-inferior to CABG for the treatment of patients with left main coronary artery disease and low or intermediate SYNTAX scores. Patients with a history of COPD were propensity score matched to those without COPD. Outcomes at 30 days and 3 years in both groups were compared in patients randomized to PCI versus CABG. RESULTS: COPD status was available for 1901 of 1905 randomized patients (99.8%), 148 of whom had COPD (7.8%). Propensity score matching yielded 135 patients with COPD and 675 patients without COPD. Patients with COPD had higher 3-year rates of the primary composite end point of death, myocardial infarction or stroke (31.7% vs 14.5%, P 0.0001), death (17.1% vs 7.5%, P = 0.0005) and myocardial infarction (18.3% vs 7.3%, P 0.0001), but not stroke (3.3% vs 2.9%, P = 0.84). There were no statistically significant interactions in the relative risks of PCI versus CABG for the primary composite end point in patients with and without COPD at 30 days [hazard ratio (HR) 0.39, 95% confidence interval (CI) 0.12 1.21 vs HR 0.55, 95% CI 0.29 1.06; Pinteraction = 0.61] or at 3 years (HR 0.85, 95% CI 0.46 1.56 vs HR 1.28, 95% CI 0.84 1.94; Pinteraction = 0.27). CONCLUSIONS: In the EXCEL trial, COPD was independently associated with poor prognosis after left main coronary artery disease revascularization. The relative risks of PCI versus CABG at 30 days and 3 years were consistent in patients with and without COPD..

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