3. EXCEL CLINICAL TRIAL
Evaluation of XIENCE stent Versus Coronary Artery Bypass Surgery for
Effectiveness of Left Main Revascularization.
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5. AIM
• To establish the safety and efficacy of the commercially approved
XIENCE Family Stent System in subjects with unprotected left main
coronary artery disease by comparing to coronary artery bypass graft
surgery
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30. • A non target vessel revascularization will be considered
ischemia-driven if any lesion the non target vessel has a
diameter stenosis ≥ 50% by QCA with any of the above
criteria for ischemia met.
85. • A target lesion (vessel) revascularization will be considered ischemia-
driven if the target lesion diameter stenosis is ≥ 50% by QCA
(analysis segment measurement, involving the lesion itself and 5 mm
of proximal and/or distal margin) and any of the following criteria for
ischemia are met:
• A positive functional study corresponding to the area served by the target
lesion;
• Ischemic ECG changes at rest in a distribution consistent with the target vessel;
• Typical ischemic symptoms referable to the target lesion;
• IVUS of the target lesion with a minimal lumen area (MLA) of ≤ 4 mm^2 for
non left main lesions or ≤ 6 mm^2 for left main lesions. If the lesions are de
novo (i.e. not restenotic), the
• plaque burden must also be ≥ 60%;
• FFR of the target lesion ≤ 0.80
• A non target vessel revascularization will be considered ischemia-
driven if any lesion the non target vessel has a diameter stenosis ≥
50% by QCA with any of the above criteria for ischemia met.
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94. Percentage of Participants With Major
Adverse Events (MAE)
• Composite of death, myocardial infarction, stroke,
transfusion of ≥ 2 units of blood, major arrhythmia,
unplanned coronary revascularization for ischemia, any
unplanned surgery or radiologic procedure, renal failure,
sternal wound dehiscence, infection requiring antibiotics
for treatment, intubation for > 48 hours, or post-
pericardiotomy syndrome.
95.
96.
97. Number of Participants With Stent
Thrombosis (ARC Definition)
Definite/Probable
• Definite stent thrombosis occurred by either angiographic/pathologic confirmation of stent thrombosis.
• Angiographic confirmation:The presence of a thrombus that originates in the stent or in the segment 5 mm
proximal or distal to the stent&presence of at least 1 of the following criteria within a 48-hour time window:
• Acute onset of ischemic symptoms at rest
• New ischemic ECG changes
• Typical rise&fall in cardiac biomarkers
• Non-occlusive thrombus
• Occlusive thrombus.
• Pathological confirmation: Evidence of recent thrombus within the stent determined at autopsy or via
examination of tissue retrieved following thrombectomy.
• Probable stent thrombosis may occur after intracoronary stenting due to:
• Unexplained death within first 30 days
• Irrespective of the time after the index procedure,any MI that is related to documented acute ischemia in the
territory of the implanted stent without angiographic confirmation of stent thrombosis&in the absence of any
other obvious cause.
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103. Number of Participants With Graft
Stenosis or Occlusion
•
Graft stenosis or occlusion is defined as Ischemic
symptoms in the presence of ≥50% diameter stenosis in a
coronary bypass graft.
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120. CONCLUSION
• High probability that PCI was associated not only with statistical
inferiority but also with clinical inferiority to CABG for treatment of
patients with LMCAD.
• However, clinicians must also recognise the need for individual
personalization and consequently acknowledge that PCI may be an
appropriate choice for selected patients, such as those with a reduced
overall life expectancy of less than 2 to 3 years or those with very high
surgical risk profiles.