Major Bleeding and Mortality After Revascularization of Left Main Disease
Primary result · 5-year MBResult — go to the resultOdds ratio 0.48 95% CI 0.36–0.65Authors' conclusion
In the EXCEL trial, CABG resulted in higher 5-year rates of all MB and in-hospital MB, although postdischarge MB was more frequent after PCI. MB after both procedures was associated with increased cardiovascular and noncardiovascular mortality within 5 years.
Study context
- Population
- Patients with unprotected left main CAD
- Participants
- 1,905 patients
- Comparison
- Percutaneous coronary intervention (PCI) vs coronary artery bypass grafting (CABG)
- PCIn = 948
- CABGn = 957reference
- Primary endpoint
- Major bleeding (TIMI major or minor, BARC 3–5, or overt bleeding requiring transfusion)
- Follow-up
- 5 years
Methodological detailsTime-adjusted Cox regression for major bleeding (MB)–mortality association
- Time-adjusted Cox regression for MB–mortality association
Primary result
5-year MB
Odds ratio
0.48
95% CI 0.36–0.65
P < 0.0001
By group
PCI vs CABG
OR 0.48 (95% CI 0.36–0.65); P < 0.0001
As reported in the abstract
Further findings
| Outcome | PCI | CABG | Estimate | P value | |
|---|---|---|---|---|---|
| In-hospital MB | 3.8% | 13.5% | OR 0.25 (95% CI 0.17–0.37) | ||
| Postdischarge MB | 4.5% | 2.0% | OR 2.33 (95% CI 1.33–3.09) | ||
| All-cause mortality after MB (MB vs no MB) · within 5 yearsDriven by CV and non-CV mortality | adjusted HR 2.71 (95% CI 1.95–3.77) | P < 0.0001 | |||
| 0.10.31310Ratio (log scale) |
- In-hospital MB: interaction P < 0.0001 (in-hospital vs postdischarge)
- Postdischarge MB: All 41 postdischarge MB events after PCI occurred on DAPT
- All-cause mortality after MB (MB vs no MB): in-hospital vs postdischarge interaction P = 1.00
- All-cause mortality after MB (MB vs no MB): PCI vs CABG interaction P = 0.95
Original publication
Major Bleeding and Mortality After Revascularization of Left Main Disease. J Am Coll Cardiol. Published 10 December 2024. doi:10.
Summarised from the published abstract; every number is checked against it