Spontaneous Myocardial Infarction After Left Main Revascularization: The EXCEL Trial
Primary result · Spontaneous MIResult — go to the resultAdjusted hazard ratio 2.01 95 CI 1.29–3.15Authors' conclusion
In the EXCEL trial, spontaneous MI occurred relatively infrequently within 5 years after LMCAD revascularization but at a higher rate after PCI compared with CABG. Spontaneous MI after revascularization was strongly related to subsequent cardiovascular and all-cause mortality, consistently after PCI and CABG, and was more strongly associated with mortality than was large procedural MI.
Study context
- Population
- Patients undergoing left main CAD revascularization
- Participants
- 1,882 patients
- Comparison
- Percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) for left main CAD
- Primary endpoint
- Spontaneous MI and its association with CV and all-cause mortality
- Follow-up
- 5 years
Primary result
Spontaneous MI · 5-year follow-up
Adjusted hazard ratio
2.01
95 CI 1.29–3.15
P = 0.002
Events by treatment group
PCI vs CABG
adjusted HR 2.01 (95 CI 1.29–3.15); P = 0.002
As reported in the abstract
- Spontaneous myocardial infarction (MI) predicting CV mortality within 5 years (adjHR)
- 9.39; 95% CI, 5.22-16.87
- Spontaneous MI predicting all-cause mortality within 5 years (adjHR)
- 4.77; 95% CI, 2.92-7.80
Further findings
Procedural MI (extensive myonecrosis) and 5-year mortality
- CV mortality (adjHR)
- 3.02; 95% CI, 1.64-5.56
- All-cause mortality (adjHR)
- 2.38; 95% CI, 1.48-3.80
- Interaction P=0.23 (CV) and 0.34 (all-cause)
Original publication
Spontaneous Myocardial Infarction After Left Main Revascularization: The EXCEL Trial. Circulation. Published 10 February 2026. doi:10.
Summarised from the published abstract; every number is checked against it