o:3211 Impact of left ventricular ejection fraction on clinical outcomes after left main coronary artery revascularization: results from the randomized EXCEL trial en AIM: To evaluate the impact of left ventricular ejection fraction (LVEF) on 3-year outcomes in patients with left main coronary artery disease (LMCAD) undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in the EXCEL trial. METHODS AND RESULTS: The EXCEL trial randomized patients with LMCAD to PCI with everolimus-eluting stents (n = 948) or CABG (n = 957). Among 1804 patients with known baseline LVEF, 74 (4.1%) had LVEF <40% [heart failure with reduced ejection fraction (HFrEF)], 152 (8.4%) LVEF 40–49% [heart failure with mid-range ejection fraction (HFmrEF)] and 1578 (87.5%) LVEF ≥50% (heart failure with preserved ejection fraction). Patients with HFrEF vs. HFmrEF vs. preserved LVEF experienced a longer postoperative hospital stay (9.0 vs. 7.0 vs. 6.0 days, P = 0.02) with greater peri-procedural complications after CABG, while hospital stay after PCI was unaffected by LVEF (1.5 vs. 2.0 vs. 1.0 days, P = 0.20). The composite primary endpoint of death, stroke, or myocardial infarction at 3 years was 29.3% (PCI) vs. 27.6% (CABG) in patients with HFrEF, 16.2% vs. 15.0% in patients with HFmrEF, and 14.5% vs. 14.6% in those with preserved LVEF, respectively (Pinteraction = 0.90). Smoothing spline analysis demonstrated that the 3-year risk of all-cause death increased when LVEF decreased, both in patients undergoing CABG and PCI. CONCLUSION: In the EXCEL trial, the composite rate of death, stroke or myocardial infarction at 3 years was significantly higher in patients with HFrEF compared with HFmrEF or preserved LVEF, driven by an increased rate of all-cause death. No significant differences after PCI vs. CABG were observed among patients with HFrEF, HFmrEF and preserved LVEF. Longer-term follow-up could provide important insights on differences in clinical outcomes that might emerge over time. Clinical Trial Registration: ClinicalTrials.gov Identifier NCT01205776. Appendix: https://unilib.phaidrabg.rs/o:3212 Key words: coronary artery bypass grafting, percutaneous coronary intervention, left main coronary artery disease, left ventricular ejection fraction, left ventricular function, heart failure with reduced ejection fraction 91552100 128200713 1552101 1388-9842 1552099 10.1002/ejhf.1681 2023-11-10T19:21:16.065Z 44 yes 46 Daniel J.F.M. Thuijs 46 Milan Milojević 106163721 0000-0003-0984-9011 2020 46 Gregg W. Stone 46 John D. Puskas 46 Patrick W. Serruys 46 Joseph F. Sabik 3rd 46 Ovidiu Dressler 46 Aaron Crowley 46 Stuart J. Head 46 A. Pieter Kappetein application/pdf 679700 https://unilib.phaidrabg.rs/o:3211 no yes 1 70 616.124-089 92000001 71A11 European journal of heart failure 22 5 871 879 2020