medigraphic.com
SPANISH

Cirugía Cardiaca en México

ISSN 2448-5640 (Print)
Diario Oficial de la Sociedad Mexicana de Cirugía Cardiaca, A.C., y del Colegio Mexicano de Cirugía Cardiovascular y Torácica, A.C.
  • Contents
  • View Archive
  • Information
    • General Information        
    • Directory
  • Publish
    • Instructions for authors        
    • Send manuscript
  • medigraphic.com
    • Home
    • Journals index            
    • Register / Login
  • Mi perfil

2020, Number 3

<< Back Next >>

Cir Card Mex 2020; 5 (3)

The Excel trial and the current clinical guidelines for myocardial revascularization: What do we need to know? Keep me in the loop! Part 2

García-Villarreal OA
Full text How to cite this article

Language: Spanish
References: 13
Page: 74-80
PDF size: 456.56 Kb.


Key words:

Clinical guidelines, Coronary artery bypass grafting, Coronary artery disease, Myocardial ischemia, Myocardial revascularization, Excel trial.

ABSTRACT

The 2018 ESC/EACTS clinical guidelines for myocardial revascularization have been our “light on the pad” since they officially appeared published in 2019. For interventional cardiologists and cardiac surgeons our highest quality standards are based upon these guidelines above. With this framework, so large a body of trials have been carried on. Excel trial is one of them into this lengthy list. The trial was initially designed in an attempt to come into the open the status of non-inferiority of the PCI compared to CABG. Unfortunately, the Excel trial has been surrounded, in a manner of saying, by many uncommon facts. All this above notwithstanding, the level of credibility of this trial has dramatically fallen far below the target levels, giving raise to the so-called “the Excel scandal”. However, cutting just to the chase, what really happened? Whereas the Excel trial Investigators state out nothing wrong is happening, the crowd claims for a further transparency of open data. However, what is truthfully necessary is to make clear if all these big-gig trials might be compared as a whole to get a true pooled effect impacting the current clinical guidelines.


REFERENCES

  1. 2018 ESC/EACTS Guidelines on myocardial revascularization. Sousa-Uva M,Neumann FJ, Ahlsson A, et al. ESC Scientific Document Group. Eur J CardiothoracSurg 2019;55:4-90. doi: 10.1093/ejcts/ezy289.

  2. Serryus PW, Morice M-C, Kappetein AP, et al. for the SYNTAX Investigators.Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting forSevere Coronary Artery Disease. N Engl J Med 2009; 360:961-72.

  3. Mohr FW, Morice MC, Kappetein AP, et al. Coronary artery bypass graft surgeryversus percutaneous coronary intervention in patients with three-vessel diseaseand left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAXtrial. Lancet 2013;381:629-38. doi: 10.1016/S0140-6736:60141-5.

  4. Thuijs DJFM, Kappetein AP, Serruys PW, et al; SYNTAX Extended SurvivalInvestigators. Percutaneous coronary intervention versus coronary artery bypassgrafting in patients with three-vessel or left main coronary artery disease: 10-yearfollow-up of the multicentre randomised controlled SYNTAX trial. Lancet 2019;394:1325-34.

  5. Ahn JM, Roh JH, Kim YH, et al. Randomized Trial of Stents Versus Bypass Surgeryfor Left Main Coronary Artery Disease: 5-Year Outcomes of the PRECOMBATStudy. HJ J Am Coll Cardiol 2015;65:2198-206.

  6. Park DW , Ahn JM, Park H, et al. Ten-Year Outcomes After Drug-Eluting StentsVersus Coronary Artery Bypass Grafting for Left Main Coronary Disease. ExtendedFollow-Up of the PRECOMBAT Trial. Circulation 2020; 141: 1437-46.

  7. Mäkikallio T, Holm NR, Lindsay M, et al. NOBLE study investigators. Percutaneouscoronary angioplasty versus coronary artery bypass grafting in treatment ofunprotected left main stenosis (NOBLE): a prospective, randomised, open-label,non-inferiority trial. Lancet 2016;388:2743-52.

  8. Holm NR, Mäkikallio T, Lindsay MM, et al; NOBLE study investigators. Percutaneouscoronary angioplasty versus coronary artery bypass grafting in the treatmentof unprotected left main stenosis: updated 5-year outcomes from the randomised,non-inferiority NOBLE trial. Lancet 2020;395:191-9.

  9. Stone GW, Kappetein AP, Sabik JF, et al. EXCEL trial investigators. Five-YearOutcomes after PCI or CABG for Left Main Coronary Disease. N Engl J Med2019;381:1820-30.

  10. Pomar JL. Lo blanco nunca es del todo blanco; lo negro nunca es del todo negro;lo gris, siempre es gris; y lo gris, a mi, no me gusta. Cir Cardiov 2019; 26: 245-7.

  11. Ruel M, Falk V, Farkouh ME, et al. Myocardial Revascularization Trials. Circulation2018;138:2943-51.

  12. https://www.eacts.org/eacts-statement-bbc-newsnight-investigation/. Accessed onMay 10, 2020.

  13. García-Villarreal OA. What about current guidelines for coronary revascularization2018 ESC/EACTS for stable angina? Part I. Stable angina. Cir Card Mex2019; 4: 114-119.




2020     |     www.medigraphic.com

Mi perfil

C?MO CITAR (Vancouver)

Cir Card Mex. 2020;5