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Is the Use of iFR for the Deferral of Left Main Coronary Artery Lesions Safe?
Deferral of left main coronary artery lesions using instantaneous wave-free ratio (iFR) seems to be safe. At the least, patients with deferred lesions had similar long-term prognosis to that of patients who underwent revascularization based on that same indicator. Left main coronary artery lesions were universally excluded from studies including medical treatment among the therapeutic…
More Data from the EXCEL and More Controversy
A thorough statistical analysis of the EXCEL has quite definitely shown that the likelihood of death, MI or stoke, including total mortality, is higher with PCI compared against CABG. The Bayesian analysis estimated a 3.3% difference in mortality, superior in the PCI arm, with 99% probability that EXCEL total mortality was indeed increased with PCI…
IVUS in Left Main Coronary Artery Angioplasty: Luxury or Necessity?
Technique advancements in left main coronary artery angioplasty have turned this procedure into a reasonable alternative to surgery, particularly in patients with a low or intermediate Syntax score and, obviously, those in whom surgery was contraindicated. Results can be credited to a refinement in technique, better drug-eluting stents, better patient selection, and frequent use of…
Virtual ACC 2020 | PRECOMBAT: 10 Years for Surgery vs. Angioplasty in Left Main Coronary Artery Disease
After 10 years of follow-up, there were no significant differences in the rates of major adverse cardiovascular or cerebrovascular events among patients with left main coronary artery disease randomized to angioplasty or surgery. Since this was the first study to randomize patients with left main coronary artery disease to angioplasty or surgery, it enrolled very few…
Virtual ACC 2020 | TWILIGHT-COMPLEX: Ticagrelor Monotherapy in the Most “Dangerous” Angioplasties
The original TWILIGHT findings in more than 9000 patients who underwent angioplasty were presented last year at TCT and showed a 3.1% absolute risk reduction in BARC 2, 3, or 5 bleeding with no increase in death, infarction, or stroke in patients who received ticagrelor and placebo compared with patients who received ticagrelor and aspirin. All patients…
Repeat Revascularization Is Not Benign, at Least in Left Main Disease
After the “EXCEL scandal” at the end of last year, study investigators have been publishing explanations and sub-studies that were planned from the beginning, but which can still be interpreted as explanations. This sub-study states that revascularization was more common in the angioplasty arm, but only revascularizations performed on the target lesion, regardless of the…
Soon after the EXCEL “Scandal” the NOBLE 5-year Outcomes Come Out: Mere Coincidence?
There is no such thing as coincidence, at least not for the evidence-based medical science. This is what the NOBLE 5-year outcomes, soon to be published in the Lancet, seem to say, in line with the BBC exposé of the EXCEL study. The NOBLE study randomized patients with left main disease to compare PCI vs…
Latest Guidelines “Dropped” After Scandal Over EXCEL Results
The European Association for Cardio-Thoracic Surgery (EACTS) formally withdrew its support for the latest coronary revascularization guidelines following a BBC investigation suggesting that data from the EXCEL trial might have been manipulated. The recommendations for left main coronary artery revascularization featured in the 2018 guidelines, which were written jointly with the European Society of Cardiology…
The EXCEL Authors’ Answer to the BBC Investigation
Do to an investigation carried out by the BBC that led to the withdrawal of EACTS support from the latest coronary revascularization guidelines, the authors of the EXCEL study (indicated by this research) provided the following answers. -Defining Peri-Procedural Infarction: All researchers involved (including surgeons) agreed that the universal definition of infarction was not right…
TCT 2019 | EXCEL: Left Main Coronary Artery Angioplasty with Favorable Results at 5 Years
Courtesy of Dr. Carlos Fava. Unprotected left main coronary artery angioplasty with drug-eluting stents has emerged as an acceptable strategy for a select group of patients, with results comparable to those of myocardial revascularization surgery at 2 or 3 years. However, beyond such term, we had no valid information. Researchers analyzed the 5-year follow-up results for the…