o:3180 Bypass surgery or stenting for left main coronary artery disease in patients with diabetes en BACKGROUND: The randomized EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial reported a similar rate of the 3-year composite primary endpoint of death, myocardial infarction (MI), or stroke in patients with left main coronary artery disease (LMCAD) and site-assessed low or intermediate SYNTAX scores treated with percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Whether these results are consistent in high-risk patients with diabetes, who have fared relatively better with CABG in most prior trials, is unknown. OBJECTIVES: In this pre-specified subgroup analysis from the EXCEL trial, the authors sought to examine the effect of diabetes in patients with LMCAD treated with PCI versus CABG. METHODS: Patients (N ¼ 1,905) with LMCAD and site-assessed low or intermediate CAD complexity (SYNTAX scores #32) were randomized 1:1 to PCI with everolimus-eluting stents versus CABG, stratified by the presence of diabetes. The primary endpoint was the rate of a composite of all-cause death, stroke, or MI at 3 years. Outcomes were examined in patients with (n ¼ 554) and without (n ¼ 1,350) diabetes. RESULTS: The 3-year composite primary endpoint was significantly higher in diabetic compared with nondiabetic patients (20.0% vs. 12.9%; p < 0.001). The rate of the 3-year primary endpoint was similar after treatment with PCI and CABG in diabetic patients (20.7% vs. 19.3%, respectively; hazard ratio: 1.03; 95% confidence interval: 0.71 to 1.50; p ¼ 0.87) and nondiabetic patients (12.9% vs. 12.9%, respectively; hazard ratio: 0.98; 95% confidence interval: 0.73 to 1.32; p ¼ 0.89). All-cause death at 3 years occurred in 13.6% of PCI and 9.0% of CABG patients (p ¼ 0.046), although no significant interaction was present between diabetes status and treatment for all-cause death (p ¼ 0.22) or other endpoints, including the 3-year primary endpoint (p ¼ 0.82) or the major secondary endpoints of death, MI, or stroke at 30 days (p ¼ 0.61) or death, MI, stroke, or ischemia-driven revascularization at 3 years (p ¼ 0.65). CONCLUSIONS: In the EXCEL trial, the relative 30-day and 3-year outcomes of PCI with everolimus-eluting stents versus CABG were consistent in diabetic and nondiabetic patients with LMCAD and site-assessed low or intermediate SYNTAX scores. Appendix: https://unilib.phaidrabg.rs/o:3181 Key words: coronary artery bypass grafting, diabetes, left main disease, percutaneous coronary intervention, SYNTAX score 91552100 128665353 1552101 0735-1097 1552099 10.1016/j.jacc.2019.01.037 2023-11-06T12:19:28.866Z 44 yes 46 Milan Milojević 106163721 0000-0003-0984-9011 2019 46 Patrick W. Serruys 46 Joseph F. Sabik III 46 David E. Kandzari 46 Erick Schampaert 46 Ad J. Van Boven 46 Ferenc Horkay 46 Imre Ungi 46 Samer Mansour 46 Adrian Banning 46 David P. Taggart 46 Manel Sabate 46 Anthony H. Gershlick 46 Andrzej Bochenek 46 Jose Pomar 46 Nicholas J. Lembo 46 Nicolas Noiseux 46 John D. Puskas 46 Aaron Crowley 46 Ioanna Kosmidou 46 Roxana Mehran 46 Ori Ben-Yehuda 46 Philippe Généreux 46 Stuart J. Pocock 46 Charles A. Simonton 46 Gregg W. Stone 46 Arie Pieter Kappetein application/pdf 641915 https://unilib.phaidrabg.rs/o:3180 no yes 1 70 616.132.2-089 1552253 71A11 Journal of the American College of Cardiology 73 13 1616 1628 2019