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

Xin Huang, Björn Redfors, Shmuel Chen, Yangbo Liu, Ori Ben-Yehuda, John D. Puskas, David E. Kandzari, B. Merkely, F. Horkay, Ad J. van Boven, Piet W. Boonstra, Joseph F. Sabik, Patrick W. Serruys, Arie Pieter Kappetein, Gregg W. Stone

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: 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. METHODS: 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. CLINICAL TRIAL REGISTRATION NUMBER: http://www.clinicaltrials.gov; NCT01205776.

Original languageEnglish
Pages (from-to)1144-1151
Number of pages8
JournalEuropean journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
Volume55
Issue number6
DOIs
Publication statusPublished - Jun 1 2019

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Percutaneous Coronary Intervention
Chronic Obstructive Pulmonary Disease
Coronary Artery Disease
Coronary Artery Bypass
Confidence Intervals
Propensity Score
Stroke
Myocardial Infarction
Stents
Clinical Trials

Keywords

  • Chronic obstructive pulmonary disease
  • Coronary artery bypass grafting
  • Left main coronary artery disease
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

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. / Huang, Xin; Redfors, Björn; Chen, Shmuel; Liu, Yangbo; Ben-Yehuda, Ori; Puskas, John D.; Kandzari, David E.; Merkely, B.; Horkay, F.; van Boven, Ad J.; Boonstra, Piet W.; Sabik, Joseph F.; Serruys, Patrick W.; Kappetein, Arie Pieter; Stone, Gregg W.

In: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Vol. 55, No. 6, 01.06.2019, p. 1144-1151.

Research output: Contribution to journalArticle

Huang, Xin ; Redfors, Björn ; Chen, Shmuel ; Liu, Yangbo ; Ben-Yehuda, Ori ; Puskas, John D. ; Kandzari, David E. ; Merkely, B. ; Horkay, F. ; van Boven, Ad J. ; Boonstra, Piet W. ; Sabik, Joseph F. ; Serruys, Patrick W. ; Kappetein, Arie Pieter ; Stone, Gregg W. / 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. In: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 2019 ; Vol. 55, No. 6. pp. 1144-1151.
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abstract = "OBJECTIVES: 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. METHODS: 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. CLINICAL TRIAL REGISTRATION NUMBER: http://www.clinicaltrials.gov; NCT01205776.",
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T1 - Impact of chronic obstructive pulmonary disease on prognosis after percutaneous coronary intervention and bypass surgery for left main coronary artery disease

T2 - an analysis from the EXCEL trial

AU - Huang, Xin

AU - Redfors, Björn

AU - Chen, Shmuel

AU - Liu, Yangbo

AU - Ben-Yehuda, Ori

AU - Puskas, John D.

AU - Kandzari, David E.

AU - Merkely, B.

AU - Horkay, F.

AU - van Boven, Ad J.

AU - Boonstra, Piet W.

AU - Sabik, Joseph F.

AU - Serruys, Patrick W.

AU - Kappetein, Arie Pieter

AU - Stone, Gregg W.

PY - 2019/6/1

Y1 - 2019/6/1

N2 - OBJECTIVES: 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. METHODS: 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. CLINICAL TRIAL REGISTRATION NUMBER: http://www.clinicaltrials.gov; NCT01205776.

AB - OBJECTIVES: 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. METHODS: 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. CLINICAL TRIAL REGISTRATION NUMBER: http://www.clinicaltrials.gov; NCT01205776.

KW - Chronic obstructive pulmonary disease

KW - Coronary artery bypass grafting

KW - Left main coronary artery disease

KW - Percutaneous coronary intervention

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